The Lancet 04/2013; 381(9874):1332. · 38.28 Impact Factor
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ABSTRACT: Abstract Maackia amurensis agglutinin is a NeuNAcα (2-3) Galβ (1-4) GlcNAc/Glc specific lectin, which was shown to have diagnostic potential in cancer of different origin. In the previous report, we have demonstrated that GM3 specific IgG from bronchoalveolar lavage fluid (BALF) of non-small cell lung cancer (NSCLC) patients interacted with ~66kDa membrane glycoprotein band of NSCLC cell lines, which was also recognized by this lectin. This observation prompted us to assess the potential of Maackia amurensis agglutinin in NSCLC. Accordingly, we examined the reactivity of this lectin with NSCLC cell lines as well as the tissue biopsies and cells obtained from fine needle aspirations of NSCLC patients. Maackiaamurensis agglutinin showed strong reactivity specifically with cells and biopsy samples of NSCLC origin. Further, this lectin was found to induce apoptosis in NSCLC cells. The mechanism of this lectin induced apoptosis involved downregulation of Bcl-XL, upregulation of Bax, release of cytochrome c and activation of procaspase-3. Collectively our results have suggested that Maackia amurensis agglutinin may have the potential to serve as a unique probe for detection of NSCLC and also as a specific apoptosis inducing agent in NSCLC cells.Biological Chemistry 03/2013; · 2.96 Impact Factor
Article: Pleural tuberculosis following lung cancer chemotherapy: a report of two cases proven pathologically by pleural biopsy.[show abstract] [hide abstract]
ABSTRACT: Malignancy per se and cytotoxic chemotherapy given for its treatment both are recognised risk factors for the development of tuberculosis (TB). However, individual case descriptions of pleural tuberculosis (TB-PE) following chemotherapy for lung cancer (LC) have not been published previously. We herein report the first two cases of histopathologically proven TB-PE following LC chemotherapy. The first patient was a 38-year-old man with stage IV non-small cell LC (adenocarcinoma) who developed TB-PE following four cycles of chemotherapy (pemetrexed-cisplatin). The second patient was a 49-year-old man with extensive disease small cell LC who developed TB-PE after six cycles of chemotherapy (irinotecan-cisplatin). In both patients, diagnosis of TB-PE was established by demonstration of granulomatous inflammation, caseous necrosis and positive stain for acid-fast bacilli in pleural biopsy specimens. Both cases responded to standard four-drug antitubercular therapy. These cases highlight the importance of carrying out an extensive evaluation for exudative pleural effusions in LC patients receiving chemotherapy, especially in countries with high TB prevalence. Attributing such pleural effusions to disease progression, without histopathological confirmation, may be associated with disastrous consequences.Case Reports 01/2013; 2013.
Article: Management of advanced lung cancer in resource-constrained settings: a perspective from India.[show abstract] [hide abstract]
ABSTRACT: Advanced lung cancer (LC) is an important cause of cancer-related morbidity and mortality in resource-constrained settings (RCSs). Cytological/pathological confirmation of diagnosis of LC is essential prior to treatment initiation for ruling out mimickers such as pulmonary tuberculosis. Accurate staging is necessary for optimal management, and investigations should be prioritized based on availability and cost-effectiveness. Platinum-based doublet chemotherapy remains the standard of care for advanced LC. Cost of therapy, lack of medical insurance and frequency of visits are important determinants of treatment regimen. EGF receptor mutation testing may not be readily available in RCSs and chemotherapy should be preferred for unselected patients with advanced non-small-cell lung cancer. Generic drugs may be more affordable than innovator brands. Treatment efficacy should be assessed with traditional end points (survival and objective response rates) as well as those relevant to RCSs (quality of life, toxicity profile and healthcare facility utilization). Issues related to LC treatment in first- and subsequent-line settings in RCSs are discussed in detail in this evidence-based review.Expert Review of Anti-infective Therapy 11/2012; 12(11):1479-95. · 2.65 Impact Factor
Article: Quantified smoking status and non-small cell lung cancer stage at presentation: analysis of a North Indian cohort and a systematic review of literature.[show abstract] [hide abstract]
ABSTRACT: Background: There are variable observations in published literature regarding smoking status and stage of lung cancer (LC) with positive, negative and no associations being reported. In particular, data regarding the association of quantified smoking status (QSS) with non-small cell lung cancer (NSCLC) stage at the time of diagnosis is limited. In India, bidi - the hand rolled form of tobacco wrapped in the dried tendu leaf - is the most common smoking product. The current study was conducted to assess stage differences, if any, based upon QSS, among newly diagnosed LC patients. A systematic review of English literature was performed for previous publications that had assessed NSCLC stage differences in relation to QSS. Collected data on demographic and disease characteristics of 654 LC patients presenting to the authors' institute was also analyzed. Smoking index (SI) was used for QSS and was defined as number of bidis and cigarettes smoked per day multiplied by years smoked. Patients were categorized as never-smokers [Group I, n=151]; light/moderate smokers (SI=1-300) [Group II, n=202] and heavy smokers (SI ≥301) [Group III, n=301]. Multivariate logistic regression analysis (LRA) was performed to derive adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among the 520 NSCLC patients, mean [standard deviation (SD)] age in groups I, II and III was 54.5 (12.5), 58.6 (9.9) and 61.2 (9.4) years respectively (P<0.001). Percentage of males in the three groups was 48.1%, 88.0%, and 97.9% (P<0.001). Age and gender differences between groups I, II and III were also significant among 134 small cell lung cancer patients with mean (SD) ages of 44.0 (10.6), 55.7 (10.3) and 58.9 (9.3) years (P<0.001) and percentage of males being 50.0%, 90.4% and 95.5% respectively (P<0.001). Among NSCLC patients, distribution in groups I, II and III respectively of squamous (28.1%, 50.0% and 57.9%) and non-squamous histologies (59.3%, 37.3% and 27.2%) differed significantly (P<0.001). Stage distribution observed for NSCLC patients in groups I, II and III respectively was as follows: stages I-IIIA (8.1%, 19.3 and 18.7%), stage IIIB (24.4%, 34.7% and 42.1%) and stage IV (67.4%, 46.0% and 39.1%). The difference was statistically significant (P<0.001). Differences remained significant (P<0.001) for presence of extrathoracic disease [ETD] (41.5%, 28.0% and 16.6%). On multivariate LRA, SI ≥301 was the only variable that was independently associated with both advanced stage (IIIB-IV) [OR=0.25 (95% CI=0.11-0.61)] and ETD [OR=0.29 (95% CI=0.16-0.53)] at presentation. Among newly diagnosed NSCLC patients in North India, significant differences exist, based upon SI, for disease stage. Heavy smoking was independently associated with lower odds of having advanced stage as well as with lower odds of having ETD at the time of diagnosis. This observation of the current study however requires confirmation by larger prospective studies.Journal of thoracic disease. 10/2012; 4(5):474-84.