Background: Escalating adjuvant treatment with capecitabine has substantially improved outcome for early-stage triple negative breast cancer (TNBC) patients. Over half of all TNBCs have a DNA copy number profile that resembles the profile found in gBRCA1m breast cancers. It is currently unknown whether BRCA1-like status leads to differential benefit from the use of adjuvant capecitabine-containing chemotherapy compared to conventional chemotherapy.Methods: Early-stage TNBC patients participated in the FinXX trial and were randomized to either adjuvant capecitabine-containing chemotherapy (TX+CEX: capecitabine plus docetaxel, followed by cyclophosphamide, epirubicin and capecitabine) or adjuvant conventional chemotherapy (T+CEF: docetaxel, followed by cyclophosphamide, epirubicin, and fluorouracil). We used an established DNA comparative genomic hybridization algorithm on low coverage, whole genome next-generation sequencing data to classify tumors as BRCA1-like or non-BRCA1-like.Results: BRCA1-like status could successfully be determined for 129/202 (63.9%) TNBC patients. During a median follow-up of 10.7 years, 35 recurrences and 32 deaths were observed. Among the 129 TNBC tumors, 68 tumors (52.7%) had a BRCA1-like profile. The beneficial effect of the adjuvant capecitabine-containing regime compared with conventional chemotherapy did not significantly differ between patients with BRCA1-like tumors (HR 0.66, 95% CI 0.24-1.83) and those with non-BRCA1like tumors (HR 0.23, 95% CI 0.08-0.69) (recurrence-free survival, unadjusted test for interaction P ¼ 0.17). No substantial differences were observed upon adjustment for standard clinico-pathological variables.
We report a case of a 64-year-old Filipino male who initially presented with chronic cough, easy fatigability, and weight loss. Work-ups lead to a diagnosis of lung adenocarcinoma with epidermal growth factor receptor (EGFR) exon 19 deletion. Patient was placed on targeted therapy with Afatinib. He was able to complete 17 months of targeted therapy with relatively stable disease before experiencing recurrence of easy fatigability. Work-ups then lead to a diagnosis of a high-grade neuroendocrine tumor consistent with small cell lung carcinoma (SCLC). Afatinib was then discontinued and the patient was started on Carboplatin and Etoposide. However, after only one cycle, the patient's symptoms progressed and the patient eventually expired. Histological transformation of EGFR-mutant adenocarcinoma to SCLC as a mechanism of resistance to targeted therapy has been documented in literature since 2006. However, to our knowledge, this is the first fully-documented case of histologic transformation occurring in a Filipino patient. As molecular targeted therapy and immunotherapy become standard-of-care in our country, it is of paramount importance that clinicians and pathologists are aware of the various mechanisms of resistance that can occur as a result of these treatments.
Background: Cancer being a lethal disease, delay in treatment may be fatal. International organizations have come up with useful guidelines for cancer management. Still the availability of resources, infrastructure, state health policy, COVID incidence and approach of healthcare professionals differ. This study aims to find out the perception and approaches of Indian oncologists -which might prove to be useful in nation specific delivery of cancer care during COVID Pandemic.Methods: After taking consent, a survey form was circulated online amongst oncologists (haemato/ radiation/ medical/ surgical) across the country and responses collected.Results: 79.2% oncologists represent private sector, 16.8% government sector. 50% oncologists were willing to postpone investigations for stable cancer patients. 42.6% willing to start treatment without knowing the COVID status, while 44.6% were against the idea and 12.9% were indecisive. 73% willing to perform surgery right away for operable nonemergency cases with a negative COVID status and rest 27 % willing to postpone surgery. Concurrent Chemoradiation (57%) was preferred over sequential approach (43%). Majority (53.5%) were comfortable prescribing chemotherapy via telemedicine. Asymptomatic COVID positive patients requiring chemotherapy 64.4% were willing to wait for the virus to resolve and then start therapy and 35.6% were suggesting some form of oral therapy and ongoing isolation. 89.1% preferred oral route if option present. 83.7 % preferred targeted therapy, 8.2% immunotherapy and rest went for other options. 93.1 % preferred day care chemotherapy during COVID and not admission. 61 % thought extended course of dexamethasone given as premedication during chemotherapy did not have a protective role for patients during COVID outbreak. Treatment initiation criteria in descending order -39.6% stage of the disease, 36.6 % performance status, 22.8% COVID status and for rest it was the cost. 91% oncologists thought nurses were at a higher risk of exposure to COVID infection than the doctors. 54.5% were not taking anti COVID prophylaxis..
Conclusions:Greater homogeneity in practice was noticed amongst oncologists of a developing nation during COVID outbreak. The above information might be useful in policy making.
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