Priyank Tripathi

BACKGROUND: This study is an overall clinical analysis of anti-programmed cell death 1 (PD1) antibodies used in a single institution, emphasizing the role of baseline peripheral blood markers as a prognostic or predictor biomarker of immunotherapy. METHODS: Sixty-one patients were retrospectively analyzed from hospital medical records. The endpoint of this study was death from any cause and the survival time was calculated from the date of start of immunotherapy to the date of death. Descriptive and survival statistics was performed using SPSS version 23. Cutoff values for baseline biomarkers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-eosinophil ratio [NER], and lymphocyte-to-monocyte ratio [LMR]) were obtained using cutp function of Evaluate Cutpoints software (R survMisc package). Pearson and Pearman correlation coefficients were used to examine the relationship of peripheral blood biomarkers. RESULTS: Nighty-eight percent of the study population had Stage IV disease and total median overall survival postanti-PD1 therapy was 10.7 months. Patients receiving more than 5 doses of anti-PD1 therapy (12.6 m vs. 4.4 m, P < 0.001) and used in front lines (18.9 m vs. 10.7 m vs. 10.1 m vs. 2.8 m in first line, second line, third line, and >3 lines, respectively, P = 0.049) were found to have an impact in overall survival. Pembrolizumab showed a better survival compared to nivolumab (17.4 m vs. 8.2 m, P = 0.049) in our study. Among baseline biomarkers assessed, NLR (cutoff - 2.81, P = 0.003) and LMR (cutoff - 5.76, P = 0.017) has shown a statistically significant relationship with immunotherapy response. NER (cutoff - 24.32, P = 0.051) and PLR (cutoff - 190.8, P = 0.072) were also found to exhibit a strong relationship with anti-PD1 therapy response. NLR exhibits a statistically significant positive correlation with PLR (r = 0.917 P < 0.001) and NER (r = 0.400 P = 0.014). CONCLUSION: Real-life data analysis of anti-PD1 use for solid cancers highlights that baseline NLR, PLR, NER, and LMR have a significant role as immunotherapy biomarkers. However, larger studies are required to further prove the specificity and sensitivity.

Aim: To study the epidemiology of Burkholderia cepacia infection in cancer patients. Objectives: •To study the patients characteristics features of Burkholderia infections. •To study the characteristics features of Burkholderia cepacia infections. •To study the pattern of antimicrobial sensitivity and resistance. •To identify the cause of infection and reduce the risk of Hospital acquired infections. Methods: This retrospective study was conducted from July 2017 to July 2018 at HCG Tertiary Cancer Hospital, Bangalore, India. Results: Total 21 patients were diagnosed with BCC infection during the study period. Those affected were mostly Female patients (80%), admitted in medical ward for chemotherapy with mostly central lines. In our study, the incidence of Burkholderia infection was mostly found with Blood Stream Infections (90%), mostly seen in those with central line associated blood stream infection (52%) and peripheral blood stream infection(38%) . Before the incidence of infection, 11 patients (52%) had already been treated with higher antibiotics including Carbapenems. In our study, all patients (100%) could be salvaged with treatment and were discharged. Conclusions: Burkholderia cepacia infection is one of the emerging infections in the tertiary cancer setting .Hospital Infection Control Committee’s regular surveillance program and the training of healthcare workers are vital to reduce the hospital acquired infections.

Cardiovascular disease is the number one cause of death worldwide in which hypertension is responsible for an annual death of 7.1 million. There exist a causal relationship between low levels of occupational and/or leisure-time Physical Activity and an increased risk of cardiovascular disease. An additional possible reasons may be reduced sleep duration/quality and individuals knowledge of their disease and its treatment. Objective: This study was conducted to assess the prevalence of hypertension and risk factors associated, concentrating on literacy status, physical exercise, occupation and sleep pattern in rural population. Method: It was a questionnaire based study carried out in two phases with Blood Pressure measurement. Result: The study results showed low literacy rate and maximum prevalence of hypertension in farmers and house wives, with a lifestyle devoid of routine physical exercises and with advancing age. Conclusion: The study concluded with the positive relationship between risk factors. Keywords: Hypertension, Physical Exercise, Literacy, Occupation, Risk Factors.

e18802 Background: SAR, a known adverse event of cancer therapy has variable severity. Despite the availability of many approved grading tools, there is still a lack of a globally applicable grading system. To address this, World Allergy Organization (WAO) created a uniform 5-grade classification system which was modified recently to be applicable for all SAR’s. This study aims to understand the incidence and severity of chemotherapy induced SAR and overall response rate (ORR) of rechallenged drugs in a tertiary cancer center. Methods: A retrospective single centered analysis of 103 patients with chemotherapy induced SAR was carried out. Patients were stratified based on age, gender, drugs given, dose number and severity of reaction. We used Modified WAO Grading System for assessing the severity. Descriptive statistics was applied to decipher the data. ORR is defined as the proportion of patients who have a partial or complete response to rechallenged drugs using RECIST Criteria for solid tumors and Lugano Classification for lymphoma. Results: Among 103 patients who reported SAR, 63.1% were female and 64.1% patients were less than 60 years of age. Among the 22 drugs, median dose number was high for Oxaliplatin (6) and Carboplatin (5). SAR was more observed with Paclitaxel (20.39%), Carboplatin (17.48%) and Rituximab (13.59%). However, carboplatin and rituximab had more incidence of grade 1 SAR(25.92% and 29.63% respectively). Grade 1 SAR (39.80%) were reported the highest followed by grade 3 (29.13%), grade 5 (13.59%), grade 2 (11.65%), and grade 4 (5.83%). Cetuximab precipitated the most grade 5 reactions (33.33%). Among patients exhibiting SAR with Paclitaxel, 42.86% were switched to alternatives, Nab-paclitaxel (28.57%) being preferred the most. Carboplatin was changed to cisplatin in 16.66% patients and Nanosomal docetaxel lipid suspension replaced docetaxel in 42.86% patients who reported SAR with carboplatin and docetaxel respectively. Rituximab was rechallenged the most (11.65%) off which one patient had reaction. ORR was observed to be 62.5% and 50% among rechallenged Paclitaxel and Rituximab respectively. The incidence of SAR is depicted in the below table. Conclusions: The study inferred that most SAR reactions occurred with Paclitaxel and Carboplatin. Oxaliplatin and Carboplatin presented with delayed SAR. Grade 1 and grade 3 reaction were relatively more. Cetuximab reported the most grade 5 reactions. ORR of rechallenged drugs should be monitored in further larger studies.[Table: see text]

We present a case of febrile neutropenia in a patient with acute myeloid leukemia caused by an uncommon bacterial species. The patient was treated with antibiotics for 14 days before being discharged. Pantoea agglomerans is a plant soil and water-dwelling agricultural organism. It is both a commensal and pathogen of animals and humans, according to earlier research. In conclusion, p. agglomerans should be considered a bacterial threat in cancer patients who are undergoing highly myelotoxic chemotherapy.