Dr Sameer Rastogi is a Medical Oncologist in All India institute of medical Sciences, leading tertiary care centre in North India. Currently, he is running only dedicated sarcoma clinic in North India. He has done Medical Oncology fellowship from Tata Memorial Centre, Mumbai. He has various publications to his credit including reputed journals like Journal of Clinical Oncology. He has received various international awards like Young investigator award from SIOP (international society of pediatric oncology) and Clinical Oncology Society of Australia (COSA) Asia pacific award during his training and is editorial member of leading Indian Journal, Indian Journal of Medical and Pediatric Oncology.
Primary Affiliation: All India Institute of Medical Sciences - Delhi , India
Osteosarcoma (OS) is a relatively chemosensitive primary bone tumor, with the peak age of onset
occurring in late childhood and early adolescence. The treatment paradigm of nonmetastatic OS has
typically been multimodality therapy, including neoadjuvant and adjuvant chemotherapy with definitive
surgery. Over the years, various permutations and combinations of chemotherapeutic agents have been
used. However, the majority of recent trials have still used high-dose methotrexate as the backbone, with
cisplatin and doxorubicin (MAP). In the last decade, various strategies targeted to improving outcomes in
OS have included the addition of a fourth drug to the three-drug MAP regimen, changing therapy according
to histopathologic response and the addition of immunotherapies. Through this review, we sought to
underscore a few pertinent issues related to chemotherapy in nonmetastatic OS, with special reference to
challenges confronted in Indian settings.
The recent article by Gulia et al1 in Journal of Global Oncology proposed a model for chemotherapy delivery in India that effectively uses district health centers, medical colleges, and apex hospitals in hierarchical chemotherapy delivery according to the complexity of treatment and ease of administration. We believe that this model, although ideal, is more of theoretical interest because previously, a three-tier system for rural health miserably failed in India
The article by Jacola et al1 addressed the issue of cognition in patients with acute lymphoblastic leukemia (ALL) treated with a uniform protocol with assessment at predecided time points. There are a few pertinent points that we want to highlight in this study or other studies considering cognition as an outcome in ALL.
Rastogi S, Mishra SV and Aggarwal A. Overall Survival as Primary End Point in Advanced Soft Tissue
Sarcoma Research International
Advanced soft tissue sarcoma is extremely complex and heterogenous
disease with dismal outcomes. The advent of newer drugs like pazopanib,
trabectedin and most recently eribulin has enabled a flexible and more
individualized approach to the treatment of advanced soft tissue sarcoma.
However, given their modest benefit, it becomes essential to evaluate if we are
using appropriate end points in the current trials and how the equation between
progression free survival and overall survival might change in future.
The first phase III randomized trial of trabectedin in soft tissue sarcoma and the approval of trabectedin by the US Food and Drug Administration closely after the publication of the recent article in Journal of Clinical Oncology by Demetri et al1 add to the pre-existing metastatic soft tissue sarcoma treatment arsenal of doxorubicin, ifosfamide, gemcitabine, docetaxel, and pazopanib. However, a drug that receives a new approval must make its niche in the context of already-existing drugs and previous literature.
Rastogi S, Sankhala KK and Chawla SP. Recent Advances in
SM Journal of Orthopedics
Sarcomas are extremely heterogenous and exceedingly rare group of malignancies. Broadly, the term ‘sarcoma’ encompasses both Soft Tissue Sarcoma (STS) including GIST (Gastro Intestinal Stromal Tumors) and bone sarcomas, though there might be some overlap between the two entities. For the years together, the standard treatment for advanced/ metastatic STS was ifosfamide and / or doxorubicin based chemotherapy. Treatment for STS in yesteryears depended largely upon general sensitivity for chemotherapy and not for individual histological subtypes or translocation studies. However, in last few years, with the advent of new agents like imatinib, trabectidin, pazopanib and eribulin, a lot of things have changed. The success in bone sarcomas during this timeframe has not been as tangible as STS but newer therapies like denosumab and Rexin G have some potential activity in selected subsets. In this review, we will try to highlight the latest advances in both advanced/ metastatic STS and bone sarcomas
Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer, and there are currently no targeted agents approved for its treatment. It is increasingly being realized that this entity by itself is quite heterogenous and the use of biomarkers can help in better characterization of its prognosis and development of appropriate therapeutic strategies. Recently, androgen receptors (AR) and their signaling cascade have been increasingly evaluated in TNBC. Their exact role in the pathogenesis and progression of the disease is still obscured. Drugs like bicalutamide and enzalutamide have shown some activity in this subtype. This review will focus on the available evidence supporting the role of androgen receptors in the prognosis of TNBC and current status of therapies targeting these receptors
Background: Gemcitabine–platinum (Gem-P) is the current standard for patients with advanced gall bladder cancer. Materials & methods: This is retrospective analysis of a prospectively maintained database of 210 patients with advanced gall bladder cancer treated with Gem-P between January 2012 and September 2013. Results: Median age was 53 years, 65.2% females. In total,158 patients had metastatic and 52 had locoregional disease. Median number of cycles was 5 (1–12). At a median follow-up of 10 months, median overall survival/progression-free survival was 10/5 months, respectively. On multivariate analysis, patients who underwent prior surgery for primary and locoregional disease had a significantly better progression-free survival and those with locoregional disease had a significantly better overall survival. A total of 45.7% received second-line chemotherapy. Conclusion: Use of Gem-P in Indian patients leads to slightly worse outcomes suggesting an aggressive biology
Fluoropyrimidines (5-fluorouracil, capecitabine, S-1, Uftoral® [UFT; Merck, Germany]) and their derivatives are effective in management of colorectal cancer. DPD deficiency is not routinely tested and is usually diagnosed after a patient has severe/grade IV toxicity secondary to the use of 5-fluorouracil or capecitabine. Once DPD deficiency is diagnosed, there are sparse data on the use of UFT or raltitrexed and there are no comparable outcome data with well-known regimens like infusional 5-fluorouracil, leucovorin oxaliplatin (FOLFOX) and infusional 5-fluorouracil, leucovorin, irinotecan (FOLFIRI). Here we report the first case series from India of DPD deficiency and the use of UFT.
Buparlisib (formerly BKM 120), an oral 2,6-dimorpholino pyrimidine derivative is a potent pan-PI3K inhibitor causing inhibition of PI3K downstream signaling including downregulation of p-Akt and p-S6R and apoptosis of cancer cells. Buparlisib is rapidly absorbed, has more than 90% bioavailability, good blood–brain barrier penetration and half-life of 40 h. Phase I trials have shown good disease control rate with tolerable toxicity profile at the recommended doses of 100 mg. The most common adverse events noted with buparlisib are rash, hyperglycemia, derangement of liver functions and psychiatric events. Several clinical trials with buparlisib alone or in combination with chemotherapy and targeted therapies are underway. Buparlisib has not yet been approved for regular use. Further randomized trials are required before buparlisib is approved for treatment of breast cancer.