Chandan Krushna Das
@pgimer.edu.in
Associate Professor of Medical Oncology /Department of Clinical Hematology & Medical Oncology
Post Graduate Institute of Medical Education & Research, Chandigarh
Scopus Publications
Scopus Publications
Kannan Periasamy, Treshita Dey, Shikha Goyal, Renu Madan, Santosh Kumar, Sudheer Kumar Devana, Thiraviyam Elumalai, Prashanth Giridhar, Sushmita Ghoshal, Rakesh Kapoor,et al.
Springer Science and Business Media LLC
Abstract Purpose The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels. Method PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas. Results A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size. Conclusion Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.
Daneshwari Kalage, Pankaj Gupta, Ajay Gulati, Kakivaya P. Reddy, Kritika Sharma, Ati Thakur, Thakur D. Yadav, Vikas Gupta, Lileswar Kaman, Ritambhra Nada,et al.
Elsevier BV
Raghuraman Soundararajan, Pavithra Subramanian, Pankaj Gupta, Pratyaksha Rana, Manika Chhabra, Shravya Singh, Ruby Siddiqui, Chandan Das, Thakur D. Yadav, Vikas Gupta,et al.
Elsevier BV
Manika Chhabra, Daneshwari Kalage, Pankaj Gupta, Ruby Siddiqui, Shravya Singh, Thakur Deen Yadav, Vikas Gupta, Lileswar Kaman, Harjeet Singh, Santosh Irrinki,et al.
Springer Science and Business Media LLC
Piyush Aggarwal, Vinisha Gunasekaran, Ashwani Sood, Kushal Gupta, Chandan Krushna Das, and Bhagwant Rai Mittal
Ovid Technologies (Wolters Kluwer Health)
Abstract Various systemic treatment options are available for advanced pancreatic neuroendocrine tumors (NETs); however, individual treatment may be suboptimally effective. Sunitinib inhibits multiple kinases and signaling pathways with delay in tumor growth, whereas peptide radioreceptor therapy (PRRT) delivers targeted radiation to the tumors in pancreatic NETs. There is a dearth of literature on the combined or tandem use of these systemic treatment modalities. We present a case of 40-year-old man with advanced pancreatic NET where PRRT or sunitinib as monotherapy had a suboptimal treatment response, but the use of sunitinib in tandem with 177Lu-PRRT reinforced the response to the treatment.
Basil Kaufmann, Dallin Busby, Chandan Krushna Das, Neeraja Tillu, Mani Menon, Ashutosh K. Tewari, and Michael A. Gorin
Elsevier BV
Asher Mandel, Chandan Das, Richard Ting, Basil Kaufmann, and Ashutosh Tewari
Mary Ann Liebert Inc
Fluorescent probes in the near-infrared range have immense potential to improve visualization of positive margins, lymph nodes, and nerves in prostatectomy. Development of fluorescent dyes and mechanisms of cellular uptake paved the way for the current emerging technologies. However, intracellular transport of fluorophores proved to be logistically challenging with respect to intraoperative deployment. Peptide-based probes with high specificity for nerves enabled broader and more rapid labeling. Key features of the ideal probe include selectivity, minimal background noise, safety, and low cost. Human neuropeptide 401 (HNP401) and oxazine-based probes perform well in these categories. As for tumor specific labeling, prostate specific membrane antigen (PSMA) is relatively selective for the prostate and can be conjugated to a fluorophore. Near infrared (NIR) spectrum emission is an ideal range for clinical imaging use, as fluorescence occurs outside the field of visible light, and tissue optical properties diverge significantly at the visible-NIR transition. Indocyanine, carbocyanine, and fluorescein derivatives are common fluorophore conjugates for the probes. Finally, to harness the power of fluorescence intraoperatively, the surgeon must look through a specialized lens. Multiphoton microscopy, optical coherence tomography, and confocal laser endomicroscopy have emerged as frontrunners in this arena. As with any evolving technology, ongoing research is expanding the applications of fluorescent intraoperative imaging in prostate surgery. Innovations in camera technology, dye selection, and image processing are refining the technique's capabilities. A core challenge of these technologies translating into the operating room relates to size and the ability to view objects at vastly different magnifications. Dual modality zoom settings are promising solutions. Furthermore, interdisciplinary collaboration between surgeons, imaging specialists, and researchers continues to drive advancements. In conclusion, fluorescent intraoperative imaging has the potential to usher in a new era of precision and safety in prostate surgery.
Piyush Aggarwal, Harmandeep Singh, Chandan Krushna Das, Ravimohan Suryanarayan Mavuduru, Nandita Kakkar, Anupam Lal, Ujjwal Gorsi, Rajender Kumar, and Bhagwant Rai Mittal
Elsevier BV
Joyita Bharati, Jhumki Das, Pandiarajan Vignesh, Kenar D Jhaveri, Arun Prabhahar, Chandan Krushna Das, Anita Singh Parihar, Ritambhra Nada, Raja Ramachandran, Amit Rawat,et al.
Oxford University Press (OUP)
Joyita Bharati, Nikita Shah, Ankuri Desai, Douglas Gladstone, Chandan Krushna Das, Maria Jacqueline Nieto, Kenar D Jhaveri, and Hassan Izzedine
Oxford University Press (OUP)
ABSTRACT Systemic mastocytosis (SM) is a disorder of excessive mast cell accumulation in tissues due to a somatic gain-of-function mutation, commonly in the KIT gene, which prevents apoptosis of mast cells. Whereas bone marrow, skin, lymph nodes, spleen and gastrointestinal tract are commonly involved, kidneys are rarely involved directly by SM. However, there are increasing reports of indirect kidney involvement in patients with SM. Novel anti-neoplastic agents to treat advanced forms of SM include non-specific tyrosine kinase inhibitors, which are reported to be associated with kidney dysfunction in some patients. SM is also associated with immune-mediated glomerulonephritis (GN) such as mesangioproliferative GN, membranous nephropathy and diffuse proliferative GN. Kidney injury, in the form of monoclonal deposition disease and primary light chain amyloidosis, is reported in SM associated with plasma cell dyscrasia. In this narrative review we discuss the various ways kidneys (and the urinary tract) are involved in patients with SM.
Swayamjeet Satapathy, Bhagwant Rai Mittal, Ashwani Sood, Chandan Krushna Das, Ravimohan Suryanarayan Mavuduru, Shikha Goyal, Jaya Shukla, and Shrawan Kumar Singh
Society of Nuclear Medicine
The prostate-specific membrane antigen (PSMA) inhibitor [177Lu]Lu-PSMA-617 has been previously demonstrated to be noninferior to docetaxel in achieving a biochemical response in chemotherapy-naïve metastatic castration-resistant prostate cancer patients. Here, we report the final analysis of overall survival (OS) for a phase 2 randomized, controlled trial. Methods: Forty chemotherapy-naïve, PSMA-positive metastatic castration-resistant prostate cancer patients were randomly assigned to [177Lu]Lu-PSMA-617 (n = 20) or docetaxel (n = 20). Thirty-five patients received treatment per the protocol. Survival analysis was done using Kaplan-Meier curves and the Cox regression model. Results: The mean follow-up duration was 33.4 mo. In intention-to-treat analysis, the median OS for the [177Lu]Lu-PSMA-617 and docetaxel arms was 15.0 mo (95% CI, 9.5-20.5 mo) and 15.0 mo (95% CI, 8.1-21.9 mo), respectively (P = 0.905). In per-protocol analysis, the median OS was 19.0 mo (95% CI, 12.3-25.7 mo) versus 15.0 mo (95% CI, 8.1-21.9 mo), respectively (P = 0.712). No significant difference in OS was observed between the 2 arms across the analyzed subgroups. Conclusion: Long-term outcomes with [177Lu]Lu-PSMA-617 administered earlier in the prechemotherapy setting are comparable to those with docetaxel.
Pratyaksha Rana, Himanshu Pruthi, Pankaj Gupta, Manika Chhabra, Raghuraman Soundararajan, Shravya Singh, Ajay Gulati, Chandan K. Das, Thakur D. Yadav, Vikas Gupta,et al.
Elsevier BV
Maninder Kaur, Pankaj Gupta, Sreenivasulu D, Pratyaksha Rana, Raghuraman Soundararajan, Daneshwari Kalage, Chandan K Das, Thakur Deen Yadav, Vikas Gupta, Lileswar Kaman,et al.
Springer Science and Business Media LLC
Raghuraman Soundararajan, Srivardhan Vanka, Pankaj Gupta, Manika Chhabra, Pratyaksha Rana, Ajay Gulati, Chandan K. Das, Parikshaa Gupta, Uma Nahar Saikia, Thakur Deen Yadav,et al.
Springer Science and Business Media LLC
Daneshwari Kalage, Pankaj Gupta, Ajay Gulati, Thakur Deen Yadav, Vikas Gupta, Lileswar Kaman, Ritambhra Nada, Harjeet Singh, Santosh Irrinki, Parikshaa Gupta,et al.
Springer Science and Business Media LLC
Yashi Marodia, Jyoti Kharel, Uma N. Saikia, Rajender Kumar, Thakur D. Yadav, Vikas Gupta, Lileshwar Kaman, Chandan K. Das, Usha Dutta, and Pankaj Gupta
American Roentgen Ray Society
Perineural invasion (PNI) indicates a worse prognosis in patients with gallbladder cancer (GBC). This preliminary retrospective study included 19 patients with GBC who underwent contrast-enhanced CT within 4 weeks before surgical resection. The GBC showed PNI on pathologic assessment in 8/19 patients. On CT, wall-thickening morphology had sensitivity of 75.0% and specificity of 81.8% for PNI; soft tissue stranding around the celiac plexus had sensitivity of 62.5% and specificity of 100.0% for PNI.
Charanpreet Singh, Uday Yanamandra, Parathan Karunakaran, Nishant Jindal, Saloni Rani Kumar, Neha Saini, Aditya Jandial, Arihant Jain, Chandan Das, Deepesh Lad,et al.
Wiley
Swayamjeet Satapathy, Chandan K. Das, Piyush Aggarwal, Ashwani Sood, Ashwin S. Parihar, Shrawan K. Singh, and Bhagwant R. Mittal
Wiley
BACKGROUND
Genomic defects in DNA-damage repair (DDR) mechanisms have been proposed to affect the radiosensitivity of prostate cancers. In this study, we intended to evaluate the prevalence of genetic alterations in a cohort of metastatic castration-resistant prostate cancer (mCRPC) patients undergoing radioligand therapy (RLT) with prostate-specific membrane antigen (PSMA)-inhibitors as well as the impact of such mutations on treatment outcomes.
METHODS
Data of consecutive mCRPC patients from 2017 to 2021 who were treated with PSMA-RLT and underwent next-generation sequencing (NGS) were collected and analyzed for response and survival outcomes.
RESULTS
In 95 patients of mCRPC treated with PSMA-RLT, 15 patients (median age: 66 years, range: 50-73 years; [177 Lu]Lu-PSMA-617, n = 12; [225 Ac]Ac-PSMA-617, n = 3) underwent NGS. The median progression-free survival (PFS) of this cohort was 3 months (95% confidence interval: 1.6-4.4 months). On NGS, 21 genetic alterations were reported in 10/15 (67%) patients, of which 13 were DDR-associated alterations involving the genes: ATM (n = 3), BRCA2 (n = 3), TP53 (n = 2), PTEN (n = 2), FANCD2 (n = 1), FANCM (n = 1), and NBN (n = 1). Overall, 5/15 (33%) patients harbored six pathogenic variants (BRCA2, n = 2; ATM, n = 1; TP53, n = 1; PTEN, n = 2). No significant difference was noted for the biochemical response, radiological response, PFS, and overall survival between the patients with and without genetic alterations.
CONCLUSIONS
Patients of mCRPC undergoing PSMA-RLT were frequently seen to harbor DDR-associated aberrations, albeit with no significant impact on treatment outcomes. Large prospective trials comparing PSMA-RLT-related outcomes in DDR-deficient and -proficient patients are required to bring out the differences, if any, in a more observable manner.
Pankaj Gupta, Soumen Basu, Pratyaksha Rana, Usha Dutta, Raghuraman Soundararajan, Daneshwari Kalage, Manika Chhabra, Shravya Singh, Thakur Deen Yadav, Vikas Gupta,et al.
Elsevier BV
Daya Krishna Jha, Manish Rohilla, Chandan K Das, Santhosh Irrinki, Harjeet Singh, Aashima Arora, Subhas C Saha, Pankaj Gupta, Harshal S Mandavdhare, Usha Dutta,et al.
Informa UK Limited
ABSTRACT Background The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis (PC) varies from 40–70%. We hypothesized that rolling-over the patient before paracentesis might improve the cytological yield. Research design and methods This was a single center pilot study with a randomized cross-over design. We compared the cytological yield of fluid obtained by roll-over technique (ROG) with standard paracentesis (SPG) in suspected PC. In the ROG group, patients were rolled side-to-side thrice, and the paracentesis was done within 1 minute. Each patient served as their own control, and the outcome assessor (cytopathologist) was blinded. The primary objective was to compare the tumor cell positivity between SPG and ROG groups. Results Of 71 patients, 62 were analyzed. Of 53 patients with malignancy-related ascites, 39 had PC. Most of the tumor cells were adenocarcinoma (30, 94%) with one patient each having suspicious cytology and one having lymphoma. The sensitivity for diagnosis of PC was (31/39) 79.49% in SPG group and (32/39) 82.05% in ROG group (p = 1.00). The cellularity was similar between both the groups (good cellularity in 58% of SPG and 60% of ROG, p = 1.00) Conclusions Rollover paracentesis did not improve the cytological yield of abdominal paracentesis. Trial registration CTRI/2020/06/025887 and NCT04232384
Madhu Chopra, Arihant Jain, Sanjeev Chhabra, Shaweta Kaundal, Charanpreet Singh, Aditya Jandial, Gaurav Prakash, Alka Khadwal, Chandan Das, Mini P Singh,et al.
Springer Science and Business Media LLC
There is limited data on the serologic antibody responses after the ChAdOx1 vaccine in patients with hematological malignancies and hematopoietic cell transplantation recipients. There is no data on the safety and efficacy of the Indian COVISHIELD™ vaccine in this population. This study reports the anti-S antibody response to the COVISHIELD™ vaccine in a prospective cohort of patients with B-cell and plasma cell malignancies and HCT recipients at a single center. The quantitative antibodies to the SARS-CoV-2 S protein receptor-binding domain in human plasma were determined by the validated Roche Elecsys Anti-SARS-CoV-2 S kit. A total of 118 patients were included over the study period from April 2021 to August 2021. The seropositivity rate at baseline and after the first and second dose of the vaccine was 39%, 66%, and 79%, respectively (p < 0.0001). The seronegative cohort had a higher median age (65 vs. 60 years, p = 0.03), were more likely to be males (81% vs. 42%, p = 0.009), had a diagnosis of B-CLPD (100% vs. 42%, p < 0.001) and were more likely to be on ibrutinib therapy (56% vs. 15%, p = 0.001). This study confirms the safety and efficacy of the COVISHIELD™ vaccine in patients with hematological malignancies.
Thayumanavan T, Harish Goyal, Harmandeep Singh, Chandan K. Das, Aravind Sekar, and Rajender Kumar
Ovid Technologies (Wolters Kluwer Health)
ABSTRACT
Nivolumab, a fully human immunoglobulin G4 anti-programmed cell death 1 antibody, provides a novel therapy option for patients with metastatic cancers. Immunotherapy agents have been associated with immune-related adverse events (irAEs), which may be detected on 18F-FDG PET/CT. Cutaneous toxicities are one of the most common irAEs in the form of maculopapular rash (eczema-like spongiotic dermatitis) and pruritus. These irAEs may lead to false-positive findings on PET/CT done during the treatment. One should be aware of the potential irAEs while interpreting PET/CT to avoid misinterpretation.
Swayamjeet Satapathy, Bhagwant Rai Mittal, Ashwani Sood, Chandan Krushna Das, Ravimohan Suryanarayan Mavuduru, Shikha Goyal, Jaya Shukla, and Shrawan Kumar Singh
Springer Science and Business Media LLC
Lutetium-177 prostate-specific membrane antigen-617 (177Lu-PSMA-617) in end-stage metastatic castration-resistant prostate cancer (mCRPC) has reported favourable outcomes. In this study, we aimed to prospectively compare the efficacy and safety of 177Lu-PSMA-617 and docetaxel in chemotherapy-naïve mCRPC patients. This was a randomized, parallel-group, open-label, phase 2, and non-inferiority trial. Chemotherapy-naïve patients with mCRPC and high PSMA-expressing lesions on 68 Ga-PSMA-11 PET/CT were randomly assigned in 1:1 ratio to 177Lu-PSMA-617 (6.0–7.4 GBq/cycle, every 8 weeks, up to 4 cycles) or docetaxel (75 mg/m2/cycle, every 3 weeks, up to 10 cycles). The primary end-point was best prostate-specific antigen response rate (PSA-RR), defined according to Prostate Cancer Clinical Trials Working Group-3 as proportion of patients achieving ≥ 50% decline in PSA from baseline. Non-inferiority margin of − 15% was pre-specified for PSA-RR. Between December 2019 and March 2021, 40 of the 45 patients assessed for eligibility underwent randomization. Fifteen of 20 patients in 177Lu-PSMA-617 arm and 20/20 patients in docetaxel arm received treatment per protocol. Of these, best PSA-RR in the 177Lu-PSMA-617 arm was 60% (9/15) versus 40% (8/20) in the docetaxel arm. The difference in the PSA-RRs between the two arms was 20% (95% confidence interval, CI: − 12–47, P = 0.25), meeting the pre-specified criterion for non-inferiority in per-protocol analysis. Further, progression-free survival rates at 6 months were 30% and 20% in the 177Lu-PSMA-617 and docetaxel arms respectively (difference 10%, 95% CI: − 18–38, P = 0.50). Overall, treatment-emergent grade ≥ 3 adverse events occurred less frequently with 177Lu-PSMA-617 than with docetaxel (6/20, 30% versus 10/20, 50%, respectively, P = 0.20). Quality-of-life outcomes improved significantly in 177Lu-PSMA-617 arm compared to docetaxel arm (P < 0.01). 177Lu-PSMA-617 was demonstrated to be safe and non-inferior to docetaxel in the treatment of mCRPC and could, thus, be potentially employed earlier in the disease course rather than being solely reserved for advanced end-stage disease. Clinical Trials Registry-India, CTRI/2019/12/022282.
Swayamjeet Satapathy, Ashwani Sood, Chandan Krushna Das, Anwin Joseph Kavanal, and Bhagwant Rai Mittal
Ovid Technologies (Wolters Kluwer Health)
ABSTRACT
The utility of β-emitter 177Lu-DOTATATE in patients of neuroendocrine tumors (NETs) with widespread skeletal metastases is limited by its relatively modest response rates and a significant concern for hematotoxicity. In such situations, targeted α therapy with 225Ac-DOTATATE can be potentially beneficial. In this report, a 46-year-old man with rectal NET and extensive skeletal metastases was treated upfront with 6 cycles of 225Ac-DOTATATE at 8 weeks' intervals. The patient showed excellent symptomatic, biochemical, and radiological response with no grade 3/4 adverse events. The first-line use of 225Ac-DOTATATE, therefore, presents a novel strategy for metastatic NETs with high skeletal disease burden.
Pankaj Gupta, Usha Dutta, Pratyaksha Rana, Manphool Singhal, Ajay Gulati, Naveen Kalra, Raghuraman Soundararajan, Daneshwari Kalage, Manika Chhabra, Vishal Sharma,et al.
Springer Science and Business Media LLC
The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management.