Background: Oncologists deal with smoking-related cancers in their daily practice, and eastern India is known to be the smoking capital of India. Objective: This study was aimed at evaluating the pattern and practice of smoking among oncologists of eastern India. Materials and Methods: This was a questionnaire-based observational study conducted from April 2017 to May 2017 at the Institute of Postgraduate Medical Education and Research in Kolkata, India. Oncologists from West Bengal were eligible to participate through a predesigned questionnaire. The questionnaire was administered to the participants through e-mail to assess the smoking pattern. The responses were received by an independent reviewer and forwarded to the investigators in a de-identified form. The data were analyzed by the investigators using simple descriptive statistical methods. Results: Out of 262 oncologists who were e-mailed the questionnaire, valid responses were received from a total of 132 (50.4%) oncologists, of which 130 (98.4%) were male and 2 (1.6%) were female. The median age of the respondents was 48 years (range, 28-72). Of these, 50 (38%) respondents were ever-smokers and 82 (62%) were never-smokers. Out of the ever-smokers (n = 50), 23 (46%) were moderate to heavy smokers; 14 (28%) were heavy smokers; 42 (84%) were current smokers; and 31 (74%) smoked daily. The median age of smoking onset was 19 years (range, 12–29), and the median duration of smoking was 78 months (range, 2-480). Peer pressure was the most common reason for smoking initiation, reported by 55% of the respondents, followed by adventure in 33%. Out of the total 76 smokers in the ever- and never-smoker groups, 43 (56.5%) attempted to quit for a median of 2 times (range, 1-6). There were 30 (69.7%) successful quitters in the group. Health concern was the most common reason to quit, whereas mental stress was the most common cause of relapse. Conclusion: Our study suggests that an alarmingly large number of oncologists from West Bengal are smokers, with the majority of them smoking daily at moderate to heavy levels.

Background: The management of several malignancies requires prolonged venous access and repeated injections. While totally implantable venous access devices (TIVADs) can help circumvent many difficulties related to repeated venous cannulation, these devices are associated with their own share of complications. Objectives: In this study, we report our experience with TIVADs, the complications associated with them and their salvage rate. Materials and Methods: This retrospective study of adult patients who underwent TIVAD insertion for cancer cytotoxic chemotherapy between January 2016 and December 2020 was conducted at Malabar Cancer Center, a tertiary cancer center in Kerala, India. The majority of the catheters were inserted using the modified Seldinger's technique into the right internal jugular vein under ultrasonographic guidance. Local anesthesia was used for pain relief during the procedure in the majority of patients. The number of catheter days, rate of complications associated with the use of TIVADs and their nature, and the salvage measures undertaken along with their outcomes were recorded. Results: A total of 37 catheters were inserted in 34 patients during the study period. The total number of catheter days was 8421, and the average number of catheter days was 227.6 days per patient. Postoperative complications developed after the insertion of 7 catheters (18.9%), the most common complication being infection. Three catheters (42.9%) could be salvaged after complications. Twenty-eight (87.5%) catheters were available for use till the end of the planned chemotherapy. Five patients are currently receiving chemotherapy and their catheters are in situ. Conclusion: TIVADs are convenient for long-term venous access in patients with cancer and provide safe and continuous venous access till the completion of chemotherapy.

Background: Esophageal epithelium being primarily squamous, numerous studies have attempted to deliver a dose of more than 60 Gy as a part of radical chemoradiation for locally advanced esophageal cancer to achieve better tumor control. Various techniques have been explored in an attempt to spare the lung and heart from receiving high doses of radiation while delivering radiation to the primary tumor. Objectives: We aimed to compare the doses received by different organs at risk (OARs) and toxicities. We also aimed to compare the overall survival (OS) and disease-free survival (DFS) between patients treated with conformal radiation therapy and Volumetric Modulated Arc Therapy (VMAT). Materials and Methods: This was a retrospective audit of standard treatment offered to patients with esophageal cancer registered at our hospital between June 2015 and August 2019 using different radiotherapy techniques. Patients were treated using conformal radiation therapy or VMAT. The radiation dose delivered varied from 50.4 Gy in 28 fractions to 63 Gy in 35 fractions, depending on the OARs according to the tumor location and histology. Patients were followed up until December 2020. The Kaplan–Meier method was used for survival analysis. The log-rank test was used to compare the OS and DFS rates in the univariate analysis, and the Cox proportional-hazards model was used for the multivariate analysis. Results: Of a total of 115 patients included in the study, 16 received radiation therapy using conventional telecobalt, 25 received three-dimensional conformal radiation therapy (3DCRT), 10 received 3DCRT plus intensity-modulated radiation therapy (IMRT) Phase-II, and 64 received VMAT. For the purpose of this analysis, the three modalities other than VMAT were categorized as conformal radiation therapy. The median follow-up period was 9 months (range, 0–55) in both groups. The mean doses and sub-volume doses received by the heart were significantly lower in VMAT compared to conformal radiotherapy (mean doses 20 Gy vs. 35 Gy, P = 0.001). There was no significant difference in acute (P = 0.39) or late (P = 0.36) pharyngoesophagitis between the two groups. The OS and DFS were not significantly different between the two groups; median OS was 13 months in the VMAT and 17 months in the conformal radiotherapy group, P = 0.8; the median DFS was 8 months versus 7 months, respectively, P = 0.16. None of the tumor-related factors, except concurrent chemotherapy, significantly affected the OS and DFS in the univariate and multivariate analyses. Conclusion: The radiation dose received by the heart is significantly lower when using VMAT compared to conformal radiation therapy. However, there is no significant difference in the survival outcomes between the two techniques. The addition of concurrent chemotherapy significantly prolongs survival.

Background: The sarcomatoid variant of squamous cell carcinoma (SCC) is an uncommon variant of head-and-neck cancer with a clinically aggressive course and poor outcomes. The data on the clinical presentation and pattern of treatment received by patients with sarcomatoid variant of SCC are scarce. Objectives: In this study, we aimed to assess the clinical presentation, intent of treatment, and the subsequent treatment-related outcomes of patients with sarcomatoid variant of SCC of the head-and-neck region. Materials and Methods: This retrospective study was conducted among treatment-naïve patients with sarcomatoid variant of SCC of the head-and-neck region who presented to the Tata Memorial Center, a tertiary care center, in Mumbai, India, between January 2012 and December 2018. The primary objective was to evaluate the stage at presentation and the intent of treatment received. The secondary outcome was disease-free survival (DFS). Variables were analyzed using simple descriptive statistical methods. DFS was calculated using the Kaplan–Meier method. Results: A total of 60 patients with sarcomatoid variant of SCC were included in the study. The median age of the patients was 51 years, with a male-to-female ratio of 5:1. The oral cavity was the most common subsite, reported in 39 (65%) patients. A total of 43 (71.6%) patients presented with advanced-stage disease, and 41 (68.3%) received curative-intent treatment. The DFS of patients who received curative treatment was 76.3 months (95% confidence interval [CI], 60.3–92.4) and that of patients who received palliative-intent treatment was 11.6 months (95% CI, 9.2–14). Conclusions: Sarcomatoid variant of SCC of the head-and-neck region usually presents with advanced-stage disease, however, has a reasonable DFS when treated appropriately with curative intent.

Background: Colorectal cancers (CRCs) arise due to the progression of acquired or hereditary premalignant lesions. Therefore, an early diagnosis is essential to devise suitable preventive strategies against CRC. Objectives: We aimed at determining the prevalence and pattern of distribution of premalignant and malignant colorectal lesions and to assess their histopathological features. Materials and Methods: This retrospective study was conducted in the Department of Pathology at the Gujarat Cancer Society Medical College, Hospital and Research Center, a tertiary care hospital in Ahmedabad, Gujarat, India, between August 2018 and July 2020. Patients with malignant or premalignant lesions in the colorectal region who underwent biopsy and surgical resection were included, regardless of their age and sex. They were categorized as premalignant or malignant after the histopathological examination. The clinical history and details related to the age, gender, and anatomical site were obtained from the hospital records. The findings were analyzed using descriptive statistics. Results: A total of 150 colorectal biopsies and resected specimens with premalignant and malignant lesions were included in the analysis. Of these, 36 (24%) were benign and 114 (76%) were malignant. There were 98 (65.3%) male and 52 (34.7%) female patients in the cohort. There were 34.7% of the patients who were in the sixth decade of life and only 0.7% were in the first decade. The most commonly involved site was the rectum (32.7%). Ulcerative colitis (UC) (63.8%) was the most common premalignant lesion, and adenocarcinoma not otherwise specified (79.8%) was the most common malignant colorectal lesion. Conclusions: Premalignant and malignant colorectal lesions usually develop in older persons and have a male predilection, with the rectum being the most commonly involved site. UC is the most common premalignant colorectal lesion, and adenocarcinoma is the most common malignant colorectal lesion.

Background: Establishing a link between diet and cancer is an epidemiological challenge, and such relationships have not been thoroughly investigated. Objectives: We aimed to explore the presence of a possible relationship between diet and colorectal cancer. Material and Methods: This case–control study was conducted at the Government Medical College, Jammu, a regional cancer center in Jammu and Kashmir in North India. We collected the dietary information from 1 year prior to the date of diagnosis for a total of 100 patients with colorectal cancer, 100 hospital controls, and 100 healthy controls. Data were collected by administering the food frequency questionnaire as a part of a personal interview. Data were analyzed using the Chi-squared test, and odds ratios (ORs) were calculated with 95% confidence intervals (CIs). Results: The risk of colorectal cancer among men who consumed alcohol was greater than that among the healthy controls (OR: 2.6, 95% CI: 1.27–5.31). Similarly, risk was greater among those who consumed hot tea (OR: 1.81, 95% CI: 0.99–3.31). The odds of developing colorectal cancer were 4–19 times higher with the consumption of red meat, while of consumption of fruits, vegetables, wheat and pulses with rice once a day conferred significant protection to participants in both the control groups. Consumption of dairy products and ghee also seemed to confer protection against colorectal cancer, ranging from 39% to 95% and 77% to 85%, respectively. The odds of consumption of pickled foods were significantly higher among those with colorectal cancer as compared to the healthy controls (OR: 2.0–3.63). Conclusions: The consumption of certain foods and beverages such as alcohol, hot tea, red meat, and pickles is associated with an increased risk of colorectal cancer. Thus, our results suggest that the risk of developing colorectal cancer is associated with dietary habits and that effective prevention is possible.

Background: Choriocarcinoma is the most common form of gestational trophoblastic neoplasia seen by medical oncologists. It is a rare condition and data related to its long-term outcomes from the Indian subcontinent are sparse. Objectives: The primary objective of this study was to assess the clinicopathological characteristics and clinical outcomes of patients with of choriocarcinoma; the secondary objective was to assess the correlation of outcomes with risk stratification. Materials and Methods: This single-center retrospective study was conducted at the Tata Medical Center, a tertiary cancer center in West Bengal, India. We identified all the cases of choriocarcinoma treated at our hospital from the electronic medical records and noted their baseline characteristics, treatment details, and clinical outcomes. Descriptive statistics were used for baseline characteristics, and the Kaplan–Meier method was used for the survival analysis. Results: A total of 24 patients were included in the study. The median age of the patients was 29 years (interquartile range, 25.9–39.5). The median time interval from the last pregnancy was 5 months (range, 0 months to 11 years). The World Health Organization risk score was low in 8 (33.3%) and high in 16 (66.7%) patients. There were 6 (25%) patients who received single-agent chemotherapy, 14 (66.7%) received the EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen, and 1 (4.7%) received the VIP (etoposide, ifosfamide, and cisplatin) regimen, with the latter 2 being given only to high-risk patients. The median follow-up was 10.9 months (95% confidence interval [CI], 4.2–28.5). The median progression-free survival was not reached (NR) (95% CI, 7.2–NR). Similarly, the median overall survival was NR (95% CI, 10.56–NR). Conclusion: Our study provides real-world data for this rare malignancy and reinforces the fact that choriocarcinoma is a highly curable disease. Despite the clinicopathological variations in the different parts of the country, the long-term outcomes are favorable.

Background: Although the multidimensional geriatric assessment (GA) is considered the standard of care, it is not uniformly practiced. In older patients with cancer, shared decision-making requires a clear understanding of the goals of therapy. Objectives: We aimed to understand the perceptions of health-care professionals of the need to assess the various domains in the GA and what would constitute worthwhile outcomes in older patients with cancer. Materials and Methods: An online questionnaire survey was conducted by the geriatric oncology group of the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India. Participants in the survey included various health professionals with an interest in the care of older patients with cancer. Data were collected in Microsoft Excel and basic descriptive statistics were performed. Results: Between July and August 2020, 234 health-care professionals responded to the survey. The respondents included predominantly medical oncologists (146, 70.9%), practicing in academic centers (148, 65.6%) from India (168, 87%). According to 46% of the respondents, over 30% of the patients in their practices were in the geriatric age group; yet, 144 (73.8%) respondents reported that they referred <10% of their older patients with cancer for a GA. Almost all the respondents agreed that it was important to check for the presence of polypharmacy, inappropriate medications, comorbidities, drug interactions, falls, function, psychological status, cognition, nutrition, social support, and quality of life in the older patients with cancer. Over 95% of the respondents thought that formal training in the GA should be part of the oncology training programs. According to 139 respondents (63%), an improvement in the quality of life or a decrease in toxicity were more important goals of cancer-directed therapy in older patients with cancer, compared to prolongation of overall survival. Conclusion: There is a recognition of the importance of performing a multidimensional GA in older patients with cancer; however, this has not translated into a widespread performance of the GA in actual practice. It would be important to address the barriers to implementing the GA in the clinic, to help optimize the care of older patients with cancer. The goals of cancer-directed therapy should be clearly discussed with the patients in order for true shared decision-making to occur.

Patients with cancer are at a high risk of morbidity and mortality from infections, due to immune alterations resulting from the underlying malignancy as well as from therapy directed towards it. We aim to review the existing literature on the burden of vaccine-preventable disease, current practices and the efficacy and safety of these vaccines in patients with cancer. We performed a PubMed search for studies on the efficacy and safety of vaccines in patients with cancer, published in English, on or after 2011 to July 2021. Searches were also made in Embase, MEDLINE, Cochrane CENTRAL, and Google Scholar. Articles for which the full text was not available, non-human studies, and those that were not in English were excluded. We screened 92 studies, and excluded 49 as they were focused on children, articles about therapeutic cancer vaccines, and vaccination in healthy populations or patients with non-malignant conditions. Finally, 43 studies were included. Most studies have shown commonly administered vaccines to be safe, with some diminution of antibody response and efficacy but with overall benefit, including mortality benefit in some cases. The key point in the vaccination of patients with cancer was found to be appropriate timing, which according to most of the existing literature appears to be before the initiation of chemotherapy or in between cycles. There is however a dearth of good literature, opening up a new area for potential research.

Non-small cell lung cancer (NSCLC) has emerged as the poster child of molecular medicine. Kirsten rat sarcoma (KRAS)-mutated NSCLC is a common yet heterogeneous entity with distinct clinical and prognostic characteristics. Therapeutically, targeting the KRAS mutation in NSCLC has been the most difficult challenge faced by scientists and drug developers and after decades of efforts, a final breakthrough in the form of KRAS G12C inhibitors has emerged. In this edition of the biomarker series, we review KRAS, its biology, clinical features, and the therapeutic options in KRAS-mutant NSCLC. We performed a thorough search in PubMed, Embase, and Scopus and finally included 59 articles to write this review.

The KRAS p.G12C mutation occurs in seen in 13% of non-small cell lung cancers (NSCLCs) and in approximately 1%–3% of colorectal and other cancers. Until the last decade, there were no approved therapies for targeting the KRAS mutation, but recently, drugs targeting the mutation have been discovered. KRAS is a small protein structurally without any deep pockets making it almost impossible to target. Furthermore, it binds in its active state with the GTP protein, with remarkably close affinity making blockage of the KRAS mutation challenging. Sotorasib is a nanomolecule that selectively and irreversibly targets the KRAS mutation. The phase 2 trial (CodeBreaK100) conducted in a total of 129 patients with advanced solid tumors harboring the KRAS p.G12C mutation showed anticancer activity in patients following multiple lines of treatment. We searched for the articles published online between 2018 and May 2021 with keywords, “KRAS mutation,” “lung cancer,” and “sotorasib.” In this review article, we have discussed the history, pharmacokinetics, dosing, important studies, toxicities, and other pertinent details of sotorasib.

Logistic regression is used to obtain the odds ratio in the presence of more than one explanatory variable. This procedure is quite similar to multiple linear regression, with the only exception that the response variable is binomial. The result is the impact of each variable on the odds ratio of the observed event of interest. The main advantage of performing logistic regression is to avoid the effects of confounders by analyzing the association of all the variables together. In this article, we explain how to perform a logistic regression using practical examples. After defining the technique, the assumptions that need to be checked are explained, along with the process of checking them using the R software.