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Aims and Objectives: The ongoing COVID-19 pandemic is having a profound impact on the current clinical trials. We wanted to document the extent of the disruption amongst Indian clinical trial sites. Materials and Methods: We conducted an online survey among oncologists in India with active trials to document their experience with challenges and novel solutions. Results: A total of 60 oncologists replied of which 40 had ongoing trials with open recruitment. Majority of them had stopped screening (55%) and recruitment (62.5%). Almost half of the sites did not have adequate infrastructure (47.5%). Almost all the sites had enrolled patients worried about the impact of COVID-19 on their health outcome (up to 87.5%). The majority of sites had problems with adherence to study schedule of events (87.5%) and administration of study medication (42.5%). A total of 55% of the sites had provided the option of virtual visits. Both investigators (75%) and sponsors/contract research organizations (67.5%) had reached out to each other to maintain study integrity. More than half the centers had difficulty related to adverse events and serious adverse events (documentation and reporting; up to 75%). Discussion: Regulatory authorities in several countries have announced guidelines on the conduct of clinical trials during the COVID-19 pandemic. Whether the disruption lasts for a short or long time, its impact on clinical trials is going to be irreparable.

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The purpose of this systematic review is to understand many aspects of vaping, like what is vaping, why it is more enticing to adolescents and young adults, what makes it more harmful than regular smoked tobacco products, subsequent health consequences, and what measures are currently being taken against this activity. A literature search was conducted in online database PubMed using search string “(((((Lung injury*[Title/Abstract]) AND Vaping[Title/Abstract]) OR electronic nicotine delivery device[Title/Abstract]) OR electronic cigarette*[Title/Abstract]) AND e-cigarettes liquid) AND electronic cigars and search filter used were “published in the last 5 years” and “Human Studies.” Similar search terms were used to search EMBASE, Web of Science, Google Scholar, and the CENTRAL database of the Cochrane Library with the help of Boolean terms. Thirty-six articles were included for a final systematic review. Many of the known brands use additives such as flavoring and thickening agents that, when used even for the short term, can cause toxicity to human lung tissues. This toxicity depends not only on the extent of the habit, but also on the variable susceptibility to lung damage, dual use with cigarettes, variability in the product design of different brands, and the liquid content used in them. Vaping may be linked with significant health issues, including respiratory diseases such as asthma, very severe forms of bronchitis such as popcorn lung, or E-cigarette, or vaping, product use-associated lung injury, and cardiovascular illnesses such as atherosclerotic plaque and myocardial ischemia. From the current systematic review, we would like to emphasize that no long-term toxicological and health studies have been carried out in humans using these vaping products and their constituents to date. Although cessation should be strongly encouraged in smokers for better quality of life, it is uncertain whether it is a universally safer option to replace cigarettes with these vaping devices.

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Cancer has been the undisputed “Emperor of All Maladies” till now. The current COVID-19 pandemic has created havoc and seems to have displaced cancer from this notorious title. This narrative examines the facts and figures that have led to this succession.

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Aims: The aim of this study is to identify clinicopathological features associated with increased morbidity and mortality in cases of “ultra-high risk” gestational trophoblastic neoplasia (GTN) and to compare initial low-dose etoposide-cisplatin (EP) induction chemotherapy with respect to etoposide methotrexate adriamycin cyclophosphamide vincristine (EMACO) regimen. Settings and Design: This was a retrospective study of patients of high-risk GTN from January 2012 to December 2016 with criteria mentioned as “ultra-high-risk group;” pathological or suspected diagnosis of choriocarcinoma, multiple (>20) pulmonary metastases or associated with hemoptysis, brain metastases, large-volume liver metastases, profuse vaginal bleeding, human chorionic gonadotropin >1000,000 IU/L, interval since the last antecedent pregnancy of >2.8 years. Subjects and Methods: Comparison between the two groups of chemotherapy regimens and the median number of chemotherapy courses required to achieve complete remission was done Statistical Analysis Used: Data were analyzed using the SPSS software version 18 and Fisher's exact test with P value statistically significant at the level of 0.05. Results: Thirty-seven cases were high-risk GTN and 24 were “ultra-high risk.” The higher percentage of patients underwent remission of disease following low-dose induction chemotherapy as compared to primary EMACO therapy, 71.4% versus 58.8%. No resistance to second-line chemotherapy was noted, and no surgical intervention was required in the patients receiving low-dose induction chemotherapy before EMACO. Conclusions: We noted a decrease in the proportion of patients developing resistance to primary chemotherapy and lesser adverse effects in those receiving initial low-dose induction EP chemotherapy.

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Ibrutinib is an irreversible BTK inhibitor, characterized by high selectivity and potency. It has revolutionized the therapy of B-cell lymphomas, especially chronic lymphocytic leukemia (CLL) and mantle cell lymphoma. Importantly, it has expanded the armamentarium for those patients who are refractory to conventional chemoimmunotherapy. This small-molecule inhibitor has shown efficacy in this difficult-to-treat subset – those with del(17p)/TP53-mutated CLL. Its immunomodulatory properties make it an excellent choice for combining with other immunotherapeutic agents such as venetoclax. The drug is not without drawbacks. The need for indefinite therapy and the presence of adverse effects such as infection, bleeding, hypertension, and arrhythmia temper our enthusiasm for this versatile drug. But overall, ibrutinib's favorable risk profile and lack of myelosuppression make it an ideal therapy for the elderly and those with multiple comorbidities.

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The world is in the grip of an obesity pandemic, with tripling of obesity rates since 1975; it is predicted that one-third of people on Earth will be obese by 2025. The health consequences of obesity are primarily thought to be related to cardiometabolic disorders such as diabetes and cardiovascular diseases. It is less well appreciated that obesity has been related to at least 13 different cancers and in future, (with increasing control over tobacco misuse and infections), obesity will be the main cause of cancers. While this is an area of active research, there are large gaps in the definition of what is an obesity related cancer (ORC) and more importantly, what are the underlying mechanisms. To an extent, this is due to the controversy on what constitutes “unhealthy obesity” which is further related to the causes of obesity. This narrative review examines the causes and measurement of obesity, the types of obesity-related cancers and possible mechanisms. The information has wide implications ranging from prevention, screening, prognosis and therapeutic strategies. Obesity related cancers should be an area of high-priority research. Oncologists can contribute by spreading awareness and instituting management measures for individual patients in their care.

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Historically, cancer is known to be a genetic disease. It is now realized that it involves epigenetic abnormalities along with genetic alterations. Epigenetics is an extra layer of instruction that lies upon DNA and controls how the genes are read and expressed. It simply means changes in phenotype without a change in genotype. In this review we aim to discuss the fundamentals of epigenetics, role of these alterations in carcinogenesis and its implications for epigenetic therapies.

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Context: Adrenal tumors can arise either from cortex or from medulla; both the regions being structurally and functionally different. Current knowledge on childhood adrenocortical tumors (ACTs), the management approach, and the outcome is limited due to limited number of cases and studies. Neuroblastoma is a neoplasm of the neural crest origin and 50% arise from adrenal medulla. Pheochromocytoma (PCC) is an exciting and rare neoplasm in childhood. Aims: To evaluate the clinical presentation, spectrum of pathology, and management of adrenal tumors in children. Subjects and Methods: The study was conducted in a tertiary care pediatric institute over 5 years on children with intra-abdominal solid tumors. Adrenal tumors were diagnosed on radiological studies and postoperatively confirmed by histopathology. Results: Sixty-three patients were operated for intra-abdominal solid tumors, and Wilms tumor (39) was the most common finding. Of 11 cases of adrenal tumors confirmed by histopathology, eight were adrenal neuroblastoma, one 14-month-old female baby was detected as PCC, while two female children presented with the features of Cushing syndrome and virilization at the age of 3 and 7 years. Postoperatively, one of them was found to be adrenal adenoma and one was found to be adrenocortical carcinoma. Conclusions: ACTs are rare and potentially fatal in childhood. Complete surgical resection is the mainstay of therapy in adrenal tumors and is curative for associated hypertension. Neuroblastoma was the third common intra-abdominal solid tumor after Wilms tumor and retroperitoneal teratoma. The patient with PCC contributed to “Rule of 10s” because of the absence of hypertension and childhood occurrence.

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Background: The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) is on the rise. Although the clinicopathologic characteristics of NENs have been previously reviewed in the literature, the data published in the Indian literature so far are sparse. This study aims to review the clinicopathological features of GEP-NENs, diagnosed at our institution, and that were classified and graded according to the World Health Organization 2010 classification system. Materials and Methods: One hundred patients with GEP-NENs presenting to our institute from August 2012 to May 2016 were analyzed retrospectively. Demographic data and tumor characteristics were expressed as number, percentage, and mean value. Tumor grade was correlated to metastasis through the Chi-square test. P < 0.05 was considered statistically significant. Results: Of the 100 cases studied, 58 were male and 42 were female. The most common primary site was the pancreas (n = 36), followed by the small intestine (n = 19), esophagus (n = 17), stomach (n = 15), colon (n = 6), rectum (n = 4), and appendix (n = 3). The incidence of neuroendocrine tumor (NET) Grade 1 (NET G1) was higher (n = 40) compared to NET Grade 2 (NET G2) (n = 25) and neuroendocrine carcinoma Grade 3 (NEC G3) (n = 35). Overall in these 100 cases, NET G1 tumors and NET G2 tumors were most common in the pancreas (n = 18/36) and (n = 13/36), respectively. NEC G3 tumors were most common in the esophagus (n = 16/17). The most common site of distant metastasis was the liver (n = 23/26). Conclusion: We elucidated the epidemiological and clinicopathological features of patients presenting to our institute with GEP-NENs.

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Endometriosis is the presence of endometrial glands outside the endometrium, and ovary is the common site for endometriosis. Endometriosis can also transform into malignant tumors. When endometriosis is present within the tumors, the term endometriosis-derived tumor applies, whereas when endometriosis is recognized adjacent to the tumor, it is called as endometriosis-associated tumor. Borderline serous tumor is surface epithelial ovarian tumor. The endometriosis-associated ovarian malignancies are clear cell adenocarcinoma and endometrioid adenocarcinoma, whereas serous and mucinous are rare malignancies with endometriosis. Here, we are presenting a case report in which endometriosis was associated with borderline serous tumor.

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Anaplastic multiple myeloma (AMM) is a rare and aggressive variant of plasma cell neoplasm. It is relatively treatment resistant when compared to conventional myeloma. It can arise de novo or transform from a preexisting plasma cell myeloma. Morphologically, AMM is recognized by the presence of immature plasma cells and pleomorphic, multilobated cells. Here, we present three cases of AMM.

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Ossifying fibromyxoid tumors (OFMTs) are rare musculoskeletal tumors of uncertain malignant potential. Most OFMTs arise from the subcutaneous tissue, skeletal muscles of extremities, trunk, or head-and-neck region. OFMTs are usually benign, but atypical and malignant OFMT have been described with recurrence and distant metastasis. Till date, the etiopathogenesis and exact line of differentiation of OFMT is still doubtful. We are presenting an unusual case of malignant OFMT of the tongue. It is a rare case of malignant OFMT affecting an unusual site.

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Ameloblastoma are benign tumors whose importance lies in its potential to grow into enormous size with resulting bone deformity. They are typically classified as unicystic, multicystic, peripheral, and malignant subtypes. Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of an odontogenic cyst but on histological examination show a typical ameloblastomatous epithelium lining, with or without luminal and/or mural tumor growth. We present a very rare case of unicystic ameloblastoma in a girl child with an age of 10 years; clinical and radiographic features of UCA, its differential diagnosis, histopathology, and current concepts of management have also been discussed in the present paper.

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Background: Cancer accounts for about 1 in 7 deaths, worldwide. Primary cancers of the hepatobiliary system are significant health problems worldwide and their management presents great challenges for the hepatobiliary specialist. The incidence of hepatobiliary malignancies is on an increasing trend in India. Study: We did a retrospective study for the epidemiologic, clinical characteristics, and outcomes of patients with cancer registering for treatment in the oncology division at the Institute of Liver and Biliary Sciences, Delhi, India, between January 1, 2017 and December 31, 2017. Results: A total of 502 new patients were registered during the study period. The majority of the patients were male (M:F 1.69:1), in the age group of 35–64 years (64.3%) and presented in advanced stages of the disease (72.7% in Stage III and IV). The most common cancers were gallbladder cancer (GBC) (29.7%) and hepatocellular carcinoma (HCC) (17.3%). GBC was the most common in females (M: F 1:1.6), 86.6% were advanced (Stage III and IV), and gallstones were present in 44.3% patients (M: F 1:2.9). Periampullary carcinoma presented in early stages (71% in Stage I and II). Survival at 6 months (n = 110 evaluable patients) was 100% for Stage I, 88% for Stage II, 73.7% for Stage III and 42.1% for Stage IV, and 62.7% overall (P < 0.001). Survival at 6 months (n = 123 evaluable patients) was 56.5% for biliary cancers, 71.4% for HCC, and 75% for nonbiliary cancers (P = 0.15). 217 (43%) patients had one visit to the hospital and 168 (34%) patients had 2–5 visits with no or little follow-up. Conclusions: Most of the disease burden was in the male gender (GBC was more common in females), in the age group 35–64 years and with advanced disease presentation (except periampullary cancer). Survival diminished significantly with increasing stage of disease. Survival was worse for patients with biliary cancers. This could be due to advanced presentation, poor follow-up, and inadequate public health awareness.

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Pleuroparenchymal fibroelastosis (PPFE) is a rare progressive interstitial lung disease presenting with predominantly upper-lobe pleural thickening and pulmonary fibrosis. While most cases are idiopathic, it is rarely seen as a complication of infection or following chemotherapy, radiation therapy, and bone marrow transplant. We describe a case of early onset and rapidly progressive PPFE as a complication of cyclophosphamide chemotherapy.

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Sooraj was an athletic teenager who is diagnosed to have blood cancer. He meets his donor and undergoes stem cell transplantation. Finally, he celebrates his second chance at life. The author pens down this experience in the configuration of a poem.

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Context: Osteogenic Sarcoma (OGS) is the fifth most common malignancy among adolescents aged 15–19. With multimodality therapy, the long-term survival has improved from 16% in the prechemotherapy era to around 70% in the postchemotherapy era. Aim: This study aims to determine the clinical profile and survival of children with OGS being treated with limb-salvage surgery (LSS). Subjects and Methods: This is a retrospective analysis of all cases of OGS (age ≤ 19) who underwent LSS at our center between June 2009 and February 2017. Baseline characteristics were noted and multivariate analysis was performed for various variables to identify predictors of survival. Results: Among 44 cases studied majority were boys (n = 27). Ninety-three percentage (n = 41) were adolescents. Stage 2 disease was 75% and Stage 3 disease was 25%. The estimated 3-year overall survival (OS) was 69% (95% confidence interval [CI] 55–86) and the estimated 3-year event-free survival (EFS) was 55% (95% CI = 41–74). OS was significantly improved in patients with >90% necrosis postneoadjuvant chemotherapy (NACT) when compared with <90% necrosis (3-year OS = 88% vs. 51%,P= 0.01) and in patients who received ≤4 cycles NACT versus >4 cycles (78% vs. 60%,P= 0.04). EFS was significantly better in patients without lung metastasis at presentation (61% vs. 29%,P= 0.04), Stage 2 disease (59% vs. 38%,P= 0.04) and >90% necrosis in the tumor post-NACT (69% vs. 35%,P= 0.02). Conclusion: Significant response to NACT predicted improved OS and EFS in children with OGS treated with LSS.

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Aim: The aim of the study was to know the sociodemographic features of cancer patients registered at a rural cancer hospital in Western India. Materials and Methods: The demographic and clinical data were extracted from the medical records of the newly registered patients at the cancer center in the calendar year 2018. Results: A total of 2813 new patients were registered who were confirmed to have a malignancy. The median age was 59 years for males and 55 years for females. Mouth, tongue, esophagus, hypopharynx, and lung were the leading five sites in men, whereas breast, cervix, ovary, mouth, and esophagus were the leading five sites in women. The proportion of cancer patients above the age of 65 years at the center was more than the other neighboring hospital-based cancer registries. The proportion of tobacco consumption in female patients was found to be higher.

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Background: Immunocompromised patients are at increased risk of infections, especially those living in poor hygienic conditions. Aims and Objectives: This study aims to assess the effect of weight, immunization status of the child at the start of treatment along with the socioeconomic status (SES), and demographic parameters, i.e., type of house, sanitary facility (SF), and source of drinking water on the duration of induction phase of chemotherapy (delayed if the patient received chemotherapy for >29 days). Materials and Methods: 110 pediatric acute lymphoblastic leukemia patients aged 1.5–14 years who underwent induction of remission from June 2015 to February 2018 were included. The immunization status and weight of the child were recorded at the start of treatment. SES was assessed using modified Kuppuswami scale and a questionnaire was used to determine various sociodemographic parameters. Results: The patients not immunized as per age (P = 0.000) and having poor demographic parameters, i.e., mud house (P = 0.000), absence of SF (P = 0.013), and nonfiltered drinking water (P = 0.005), had significant delay. The duration of induction phase of chemotherapy was not delayed with poor SES (P = 0.832). Although the duration was delayed in patients with weight ≥10 percentile, it was not statistically significant (P = 0.079). On analyzing the three demographic parameters together as Water-Sanitary Facility-Housing (WaSH) Score (0–4), the duration was also significantly delayed if the patients had WaSH score <2. Conclusion: The duration of induction phase of chemotherapy is delayed with inadequate immunization status and poor hygiene of the child.

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Choriocarcinoma can occur at ectopic extragenital locations such as lungs, mediastinum, retroperitoneum, and even in the brain (nongestational choriocarcinoma). Choriocarcinoma arising in the urinary bladder is extremely uncommon with only a few cases reported worldwide. It is important to recognize and give comprehensive diagnosis of this entity, as it has poorer prognosis as compared to the conventional gestational choriocarcinoma and requires stepped-up chemotherapy. Here, we present such a case in a 19-year-old girl and the diagnostic conundrum associated with it.

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Chronic myeloid leukemia (CML) is the most common leukemia presenting with priapism. Due to social stigma or shyness, the real incidence of priapism in our population is difficult to estimate. Since the successful development of tyrosine kinase inhibitors, the life expectancy of CML-chronic phase (CML-CP) has been comparable to the healthy population, and the importance of priapism has further magnified. As of now, the long-term outcome and fertility issues are not very well known. We present the case of a 24-year-old previously healthy gentleman who presented with priapism and was diagnosed as CML-CP. He achieved major molecular response at 18 months. On follow-up at 2 years since the diagnosis, he offers no complaint except moderate erectile dysfunction (International Index of Erectile Function score 11), compromising his quality of life.

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Anti-programmed cell death-1 (PD-1)/PD ligand-1 immune checkpoint inhibitors (ICIs) are the newest class of drugs approved for various advanced cancers. Pembrolizumab, an anti-PD1 inhibitor, is approved for treating advanced-stage solid malignancies and refractory lymphomas. Recently, it has been approved as tumor agnostic therapy for microsatellite instability-high advanced-stage disease. In all these studies, pembrolizumab has shown dramatic efficacy with lesser Grade3/4 immune-related adverse events. Contemporarily, immunotherapy paved the way for diagnostic assays and immunotherapy-related response assessment criteria definitions. No published Indian experience with ICIs exists other than isolated case reports. This article aims to review on pembrolizumab mechanism, its indications, and safety. The description of other ICIs is beyond the scope of this review.

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Renal metastasis from Hurthle cell thyroid carcinoma is an extremely rare phenomenon which when present usually indicates widely disseminated disease. Herein, we present a case of Hurthle cell carcinoma of thyroid in a 58-year-old gentle lady, with metachronous renal metastasis which happens to be the fourth reported case in English literature.

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Concomitant endobronchial lesion and pericardial effusion/extension in Hodgkin lymphoma (HL) are extremely rare and can be clinically confused with disseminated tuberculosis or aggressive non-HL changing both management and prognosis. We present a 15-year-old adolescent with complaints of fever, weight loss, and acute onset of cough, chest pain, and breathing difficulty. Computed tomography of the thorax showed moderate-to-significant pericardial effusion/extension with significant mediastinal adenopathy. A bronchoscopy demonstrated a well-defined polypoidal mass lesion in the right upper lobe bronchus. Endobronchial biopsy of the lesion with endobronchial ultrasound/transbronchial needle aspiration of mediastinal lymphadenopathy categorically diagnosed with classic HL.

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Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial tumor first described in 2003. It is a newly recognized entity and introduced in the WHO classification of central nervous system tumors in 2007. Till date, about 70 cases have been described in literature. Herein, we report an additional case of PTPR in a 25-year-old male with emphasis on immunohistochemistry and ultrastructural features. Interestingly, this case showed a unique membranous as well as dot-like Golgi zone keratin (AE1/AE3 and CK18) expression pattern.

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