Myelodysplastic syndromes are haematological disorders that occur due to a defective marrow producing abnormal blood elements and characterized by decreased levels of Haemoglobin, leucoytes and platelets. For most of these disorders the only curative option is bone marrow transplantation (BMT). However BMT is not always possible due to unavailability of a matched donor.

In a study published in the February issue of the New England Journal of Medicine researchers from the Brigham and Women’s Hospitals, Harvard, Boston were able to detect mutations which predict a worse survival after BMT. For example patients with TP53 and RAS gene mutation are likely to have worse outcome even after transplantation. The clinical implication of this study lies in the fact that clinicians can now better choose which of the MDS patients should be taken up for transplant.

Cancer of the prostate is the most common solid cancer in men in the west. It is a disease of the elderly and is androgen dependent. Thus the mainstay of treatment is androgen deprivation therapy.

In a study published in the New England Journal of Medicine researchers from the Massachusetts Cancer Hospital in Boston have shown that addition of anti androgen Bicalutamide for two years to Radiotherapy at the time of recurrence in Carcinoma prostate leads to a significant improvement in the overall survival compared to only Radiotherapy.

The standard of care till now in localized recurrence was Radiotherapy only. There were though more number of side effects due to androgen deprivation such as troublesome gynaecomastia.

The results from the study again indicate that ADT is the cornerstone of management in cancer of the prostate.

Lung cancer is the most common cancer among males in India. A subset of metastatic lung cancer that is driven by mutations in the EGFR (Epidermal Growth Factor Receptor) occur in non smokers and have a favourable outcome when treated with TKI (Tyrosine Kinase Inhibitors) such as Gefitinib and Erlotinib.

However a large subset of patients progress on the TKI and are then treated with chemotherapy; typically Pemetrexed and Cisplatin. Many of these patients have a resistant mutation that makes them unresponsive to TKIs.

Osimertinib is a TKI that specifically targets one of these resistant mutations (T790M).In a recent study , patients with metastatic lung cancer who had progressed on the TKIs and harboured a T790M mutation were randomized to receive either Osimertinib or chemotherapy with Pemetrexed/platinium. Treatment with Osimertinib resulted in a significant improvement in the median progression free survival by approximately 6 months.

There were significantly higher responses and reduced toxicity in the Osimertinib arm. One important finding in this study was the improvement in survival among patients with metastases in the brain, suggesting that Osimertinib might cross the blood brain barrier.

Cancer staging is a way in which doctors find out how far a cancer has spread.

The right treatment for you will depend a lot on the stage of your cancer, your age, and other health problems. Your treatment will also depend on whether you might want to get pregnant in the future.

Ceritinib is a small molecule tyrosine kinase inhibitor approved for the treatment of ALK positive lung cancer. In patients with advanced NSCLC Ceritinib was compared to chemotherapy.

The results were very encouraging. Progression free survival was doubled with Ceritinib. (16 months vs 8 months) The subset of patients with brain metastases , traditionally a subset with very poor outome also benefitted from the new drug. Strangely there was higher number of toxicity and dose reduction with Ceritinib in comparison to chemotherapy.

Considering the cost benefit ratio Crizotinib may still be the preferred 1st line drug for ALK positive NSCLC

Gall bladder cancer is prevalent in northern and north eastern India mainly centred around the Gangetic and Brahmaputra belts. Majority of the patients present in the advanced stage and survival is in months inspite of the current standard of care.The problem is that whereas large strides have been made in unlocking the molecular mechanisms of cancer of the breast and ovary ; very little is known about the genetics of gall bladder cancer.

In a landmark study researchers from TMH (Tata Memorial Hospital),Mumbai and NCI (National Cancer Institute),US two genes have been identified in patients with Gall bladder which could cause the disease. These are the ABCB4 and ABCB1 genes. The study found that in comparison to the general population patients with Ca GB have higher prevalence of these genetic mutations.

Ca GB is very common in Odisha. Sadly we have no information about its prevalence.We should take part in the current trials on Gall bladder cancer in India.

The discovery of these new genes could lead to new drugs that target them.

Published on 5th march 2017;The Lancet Oncology