@aiimsrishikesh.edu.in/a1_1
Associate Professor Medical Oncology
All India Institute of Medical Sciences Rishikesh
Oncology, Medicine, Oncology, Internal Medicine
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Gaurav Karna, Amit Sehrawat, Saurabh Karna, Ravi Kant, Deepak Sundriyal, Summi Karn, and Dipesh Jha
Wiley
AbstractBackgroundNoncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer‐directed therapy.MethodsOver 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional‐based prospective observational study. All participants over 18 years of age, treatment‐naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer‐directed standard therapy. These data were analyzed, processed, and presented as results.ResultsThe mean age of participants was 50.45 years, with a near‐equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new‐onset endocrine disorders during cancer‐directed therapy was only 3% for diabetes and 4% for thyroid dysfunction.ConclusionAnalysis of sociodemographic and cancer‐related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction.ImplicationsOur study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer‐directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long‐term effects of cancer‐directed therapy on endocrine health and develop tailored management strategies for this vulnerable population.
Mayank Kapoor, Amit Sehrawat, Shalini Rajaram, and Deepak Sundriyal
Springer Science and Business Media LLC
Mayank Kapoor, Amit Sehrawat, and Deepak Sundriyal
Georg Thieme Verlag KG
AbstractTrilaciclib, a novel cyclin-dependent kinase 4/6 inhibitor, has demonstrated the ability to protect bone marrow from chemotherapy toxicity, improving patients' quality of life (QoL). This review describes the mechanism of action, efficacy, and toxicity profile of trilaciclib. Trilaciclib halts retinoblastoma protein phosphorylation during the early G1 phase, preventing the transition from the G1/S phase and inducing the cell cycle arrest in the G1 phase, which protects the hematopoietic cell lineages. Trilaciclib is indicated by the United States Food and Drug Administration and National Comprehensive Cancer Network to decrease the incidence of chemotherapy-induced myelosuppression in adult patients before a platinum/etoposide or topotecan containing regimen for extensive stage small cell lung cancer. Its ease of administration as an intravenous infusion, given before starting chemotherapy, and the favorable side effect profile make it a better-tolerated drug, improving patient QoL.
Akansha Vyas, Ashi Chug, Amit Sehrawat, Saurabh Simre, Jasmine Porwal, and Preeti Kolse
Springer Science and Business Media LLC
Ashwin Oommen Philips, Sunu Cyriac, P. Unnikrishnan, Anil T. Jose, Krishnakumar Rathnam, S.V. Saju, Smita Kayal, Soumya Surath Panda, Lalatendu Moharana, Sindhu Kilaru,et al.
Georg Thieme Verlag KG
Using immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, but access and affordability remain significant challenges, particularly in resource-constrained settings. This multicenter study evaluated the utilization, outcomes, and challenges associated with ICIs in India. Data from multiple centers involving patients treated between January 2018 and December 2021 were retrospectively collected. Patient demographics, treatment indications, biomarker testing, financial coverage, toxicity, treatment discontinuation, clinical benefit, progression-free survival (PFS), and overall survival (OS) were analyzed. Ninety-one patients were analyzed; lung cancer (39.6%) and renal cancer (11%) were the main indications for ICI use. Programmed death ligand 1 expression was tested in 40.7% and tumor mutational burden in 3.3%. Financial constraints influenced 41.8% of patients with out-of-pocket expenses. Treatment discontinuation due to financial constraints occurred in 17.6%, with 50% showing ongoing responses. The median number of cycles was 4; the median PFS was 4.6 months, and the median OS was 15.4 months. The lung cancer cohort had a median PFS of 5.7 months and a 1-year OS of 57.6%. Limited biomarker testing and 6.6% grade ¾ toxicities were observed. This study revealed challenges in ICI utilization in resource-constrained settings driven by financial constraints. Compared with prior studies, improved outcomes reflect better patient selection and evolving understanding of ICI use. However, in the absence of biosimilars, cost remains a significant barrier. Solutions to increase access include using lower doses, which may be as effective.
Lalatendu Moharana, Soumya Surath Panda, Suma Devaraj, Ghanashyam Biswas, Ganesh Chandra Subudhi, Prasant Kumar Parida, Sourav Kumar Mishra, Jogamaya Pattnaik, Sambit Mohanty, Sukanya Karunanidhi,et al.
Georg Thieme Verlag KG
The Anaplastic lymphoma kinase inhibitors (ALKi) represent the standard of care for metastatic non-small cell lung cancer (NSCLC) patients with EML4-ALK rearrangements. Various ALKi agents are available; however, not all eligible patients receive treatment with them due to various reasons. Given the limited real-world data available in our country, we aimed to assess treatment outcomes through a multicenter collaboration. This retrospective, multi-institutional study was conducted under the Network of Oncology Clinical Trials India and included a total of 67 ALK-positive metastatic lung cancer patients from 10 institutes across India, with a median follow-up of 23 months. In the first line setting, the objective response rate (ORR) with ALKi was 63.6% (crizotinib: 60.7%, ceritinib: 70%, alectinib: 66.6%, p = 0.508), while with chemotherapy, it was 26.1%. The median progression-free survival (mPFS) for the first line ALKi group was significantly higher than that for chemotherapy (19 vs. 9 months, p = 0.00, hazard ratio [HR] = 0.30, 95% confidence interval [CI]: 0.17–0.54). The mPFS for crizotinib, alectinib, and ceritinib was 17, 22, and 19 months, respectively (p = 0.48). Patients who received ALKi upfront or after 1 to 3 cycles of chemotherapy or after 4 or more cycles of chemotherapy had mPFS of 16, 22, and 23 months, respectively (p = 0.47). ALKi showed superior mPFS compared to chemotherapy in the second line (14 vs. 5 months; p = 0.002) and the third line (20 vs. 4 months; p = 0.009). The median overall survival (OS) was significantly better in patients who received ALKi in any line of therapy (44 vs. 14 months, p < 0.001, HR = 0.10, 95% CI: 0.04–0.23). Brain progression was higher among those who did not receive ALKi (69.2 vs. 31.5%). In conclusion, the use of ALKi as first line treatment for ALK-positive metastatic NSCLC patients resulted in improved PFS. PFS and ORR did not significantly differ between patients who received ALKi upfront or after initiating chemotherapy. Notably, patients who received ALKi in second or later lines demonstrated significantly better outcomes compared to those receiving chemotherapy. The use of ALKi in any line of therapy was associated with significantly prolonged OS.
S. S. Panda, S. S. Mohanty, A. Sanyal, P. Ganesan, S. Kayal, K. Rathnam, S. V. Saju, S. Cyriac, P. Unnikrishnan, A. Sehrawat,et al.
Georg Thieme Verlag KG
Gastric cancer (GC) is often ignored at a young age, which frequently leads to tragic consequences. The worldwide incidence of GC is increasing at a young age. In view of the limited Indian publication, we sought to characterize clinicopathological parameters and risk factors in the adolescents and young adults (AYA) population. Retrospective data from six centers (which are part of the Network of Oncology Clinical Trials in India) from 2015 to 2020 were collected from patient (18–39 years of age) records. This study was approved by the institutional ethical committee of individual centers. All statistical analyses were performed using Microsoft Excel and SPSS (Version 20). Data interpretation along with the analysis of obtained results was carried out using the following tests: Qualitative data was expressed in terms of frequency/percentage. One-hundred fifty-two AYA GC patients were enrolled. The 31 to 39 years age group was most affected in which 76.3% were females. The majority of patients were nonalcoholic (93.4%), nonsmokers (98.0%), and without a family history (98.0%). The most common (MC) presenting symptom was abdominal pain (67.1%). MC site was antrum (48%). Among esophagogastric junction cancers, the majority were type I and II Siewert classifications (77% [20/26] patients in cardia), MC histology—signet ring cell (67.1%) followed by diffuse-type (65.1%). Most were poorly differentiated (65.1%) and were diagnosed at an advanced stage (III & IV= 54.6%). This is one of our country's first large multicenter studies on GC in the AYA population. There was a higher female prevalence, aggressive tumor behavior and the majority of patients were diagnosed at a more advanced stage. The majority were nonsmokers with a negative family history. Awareness among general people, researchers, clinicians, and policymakers must be improved to better the loss of life years in the younger population.
A. Thaduri, A. Sehrawat, D. Poonia, Anindya Das, Rajesh Kumar, A. Varghese, L. Chadha, R. Seenivasagam, P. Garg, Deepak Sundryal and M. Gupta
Background: COVID-19 is one of the most unfortunate events seen in the 21st century. Cancer care providers (CCPs) are under immense mental burden due to the unpredictable pandemic and compromised cancer care among patients. The pandemic has taken a toll on caregivers, be it physically, mentally, or psychosocially. Hence, a longitudinal study was planned to evaluate the temporal changes and the impact of COVID-19 on CCPs. Subjects and Methods: A prospective longitudinal study was conducted from May 2020 to October 2020 to assess the pandemic's impact on mental health among CCPs. Depression, Anxiety, and Stress Scale-21 and PCL5 instruments were used to identify the temporal change with pandemic evolution. An online survey was administered at 6-week intervals through e-mail. Quantitative data were presented as mean with standard deviation, and an independent t-test was used to compare the mean score between the three surveys. Categorical variables were presented in percentages, and the Chi-squared test was used to analyze the differences in categorical variables between different surveys. Results: The questionnaire was e-mailed to 240 CCP's; 115 responses were valid. The mean age is 29.9 ± 5.86, 62.6% were male and 27.4% were female, 41.7% were nursing staff, and 58.3% were doctors. Sixty-seven percentage had <5 years of medical experience. Respondents who stayed with family had significant depression levels in the first and third surveys (odds ratio [OR]: 0.37, confidence interval [CI]-0.15–0.91, P = 0.03) and (OR: 0.17, CI-0.026–1.1, P = 0.04). Stress levels were significantly high in the caregivers staying with family in the first survey (OR: 4.38, CI: 1.2–15.7, P = 0.02). On analyzing three surveys, 55 respondents in both the first and second survey and 21, 8, and 17 respondents persisted in having depression, stress, and anxiety. Conclusions: Pandemic has severely affected the mental well-being of CCPs, with more than one-third of them suffering from depression, anxiety, and stress. In any disaster or an unnatural event, time helps the human mind acclimate to new conditions; it is similar to our initial results that show improvement in depression, stress, and anxiety levels with the second survey. It is crucial to assess and address mental health-related problems to ensure health-care workers well-being and deliver quality health care to the patients.
IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months.ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality.ConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.
Deepak Sundriyal and Amit Sehrawat
Medknow
Deepak Sundriyal, Parmod Kumar, Ujjawal Kumar, and Amit Sehrawat
Wiley
Geriatric age group patients with poor performance status and advanced stage cancer are often denied chemotherapy. In this series of cases, we demonstrated that systemic anti‐cancer therapy can be considered in these patients after a meticulous modification of the chemo‐protocol.
Parmod Kumar, Samaksh Sharma, Deepak Sundriyal, Shiv Charan Navria, and Amit Sehrawat
Springer Science and Business Media LLC
Deepak Sundriyal, Uttam Kumar Nath, Parmod Kumar, Sweety Gupta, Deepa Joseph, Sudeep Vaniyath, Rituparna Chetia, Anamika Bakliwal, Debranjini Chattopadhyay, Gaurav Dhingra,et al.
Georg Thieme Verlag KG
Background and Objectives The newly established medical oncology and hemato-oncology center at the All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, provided us an opportunity to audit in-hospital mortalities with a vision that the audit will serve as a standard for ceaseless improvement. Aim of the study was to initiate a vigorous process for the evaluation of all-cause mortality in patients suffering from cancer. Methods An audit of all in-hospital deaths that occurred during the year 2019 was performed, and comprehensive scrutiny of various parameters (demographic, clinico-pathological, therapeutic, causes of death) was done. Reviews from two independent observers sharpened the infallibility of the audit. The lacunae in the existing practices and the scope for further improvement were noted. Results Forty-five in-hospital deaths were registered during the study period (January–December 2019). The majority of the deaths occurred in patients with advanced stage of malignancy ([n = 31] 68.8%). Most common causes of death were progressive disease, neutropenic, and non-neutropenic sepsis. Chemotherapeutic agents, growth factors, blood components, and antibiotics were found to be used judiciously as per institutional policy. The reviewers emphasized on the use of comorbidity indexes in the treatment planning and avoiding intensive care unit referrals for patients receiving best supportive care (BSC). Emphasis was put on providing only BSC to the patients with a very limited life expectancy. Emphasis was also laid down on record of out of the hospital deaths. Interpretation and Conclusion The audit disclosed areas of care which require further improvement. The mortality audit exercise should become a regular part of evaluation and training for the ongoing and future quality commitment. This should impact the clinical decision making in an oncology center providing quality care to the terminally ill patients.
Dharma Ram Poonia, Suhas Kodasoge Rajappa, Ajay K. Dewan, Amit Sehrawat, Chaturbhuj Agrawal, and Koyyala Venkata Pradeep Babu
Springer Science and Business Media LLC
A. Sehrawat, Parmod Kumar and D. Sundriyal
Abhinav Thaduri, Dilip Dungala, Achyuth Panuganti, Kinjal Shankar Majumdar, and Amit Sehrawat
Elsevier BV
Gyanendra Swaroop Mittal, Deepak Sundriyal, Niranjan B. Naik, and Amit Sehrawat
Georg Thieme Verlag KG
Abstract Background Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the complications associated with chemoport insertion in various cancer patients. Material and Methods A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason. Results Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal. Conclusion There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.
Pallavi verma, Amrita Gaurav, Sandipan Choudhuri, Shivaani Arora, Neha Kumari, Amit Sehrawat, Parmita Tiwari, and Jaya Chaturwedi
Springer Science and Business Media LLC
ManojKumar Gupta, DharmaRam Poonia, and Amit Sehrawat
Medknow
Lima Arya, Deepak Sundriyal, Rekha Bhandari, Ruchi Srivastava, and Amit Sehrawat
Springer Science and Business Media LLC
Amit Sehrawat, Gyanendra Swaroop Mittal, Deepak Sundriyal, Anushree Chaturvedi, and Deni Gupta
Springer Science and Business Media LLC
Yumkham Monica Devi, Amit Sehrawat, Prasan Kumar Panda, and Uttam Kumar Nath
BMJ
While lymphopenia has been a common finding in COVID-19 infection, particularly in severe cases, febrile neutropenia has been very rarely reported in immunocompetent patients with COVID-19. Herein, we report the case of a 76-year-old hypertensive and diabetic man who was hospitalised with severe COVID-19 infection and developed delayed-onset severe neutropenia with neutropenic fever, which responded to treatment with antibiotics and granulocyte colony-stimulating factor. This case highlights the importance of identifying a rare complication (febrile neutropenia on the fifth week) of COVID-19 infection in hospitalised patients by intensive monitoring and aggressive management for favourable outcomes.
Parmod Kumar, Megha K Mukundan, Amit Sehrawat, and Deepak Sundriyal
Wiley
Tripe palms (TP) is one of the rare cutaneous paraneoplastic manifestations of various intra‐abdominal malignancies. TP and malignant acanthosis nigricans (MAN) occur together and may precede even years before the index cancer. Though rare, the clinical significance of TP and MAN holds significance as an indicator of internal malignancy.