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Reason for rejection of a RCT manuscript done in India.
Reviewer.
1. Reported survival is low (which is the reality).
2. Hi fi molecular testing not performed (expensive and not available).
When will 10% of the world realize the reality of 90% of the world.
#GlobalOncology
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Dear Sir
@narendramodi
@PMOIndia
@mansukhmandviya
@MoHFW_INDIA
Every year about 77, 000 children with cancer are diagnosed in India. Which is 20% Global burden. Only 26,000 (34%) reach a cancer centre. Kindly requesting you to include pediatric cancer in national cancer policy.
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Oncologists in LMIC should stop prescribing a neutropenic diet to cancer patients.
Our study shows it does not reduce infection.
@BMJ_SPCare
@CI_WIA
Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial
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Academic twitter I need some motivation.
Completed 2 large investigator initiated RCTs one of them multicenter.
Trial 1 rejected by 7 journals despite positive reviews.
Trial 2 rejected by top journal in the field.
Both selected only as posters in international conferences.
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#IndiaAtAsco
#ASCO23
The top cancer centers from India
Cancer Institute Chennai
TMC Mumbai
AIIMS New Delhi
PGI Chandigarh
have presented practice changing data at the International level
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📖 Our multi-centre study:
2 drug vs 3 drug induction in pediatric acute myeloid leukemia
✅ No benefit in survival with addition of 3rd drug etoposide (ADE) to dauno and ARAC (3+7)
✅ Similar toxicities
✅ First INPHOG RCT
✅ First RCT on AML from LMIC
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✅ 80% of pediatric cancers occur in LMICs
20% in HICs
✅ 20% of pediatric cancer survive in LMICs
80% in HICs
❌ 80-90% of oral presentations in conferences are from HICs
10%-20% from LMICs
How will we improve survival in LMICs to 60% by 2030 if their voices aren't heard
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Female sex is the most important factor for treatment abandonment in pediatric patients with cancer treated at AIIMS New Delhi.
@drsameerbakhshi
#SIOP2023
#SIOPambassador
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Thank you
@ConquerCancerFd
for awarding me and
@CI_WIA
the prestigious international innovation grant. The grant will help us in improving patient care, outcomes and conducting innovate research.
@ASCO
@stjudegraduate
@StJudeResearch
Congratulations to the 2022 recipients of the Conquer Cancer International Innovation Grant (IIG):
@drdharmapoonia
,
@FrancineKouya
, Venkatraman Radhakrishnan, MD, MBBS, MSc, DM,
@AsimaMukhopadh1
, and Regi Jose, DPH, DNB, MD, MPhil, MBBS.
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Please vote for
@cspramesh
The most deserving candidate to represent the Global Oncology community in ASCO
Thrilled to hear about Dr.
@cspramesh
’s nomination to the
#ASCO
Board of Directors. His dedication and visionary approach are truly commendable. I feel privileged to have learned from him during
@credoworkshop
. Big-time congratulations on this achievement🌟
#ASCO
#leadership
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#ASCO23
is nothing less than once in a life time pilgrimage for professionals from resource limited settings. Many hurdles to clear
Visa
Long flights
Immigration questioning
Financial drain: visa fees, abstract fees, registration, flights, accommodation, transportation, food
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Poster presentation at a big meeting like
#ASCO23
can be humbling. You go with the idea that your research is path breaking and exciting, only to realize that most don't share your enthusiasm. It's just you and your poster and no one turns up. Sitting all alone you reflect
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"The most important drug for improving survival in pediatric oncology in resource limited settings and LMICs is NUTRITION." Quote: self.
Our data has consistently shown across all pediatric cancers, malnutrition reduces survival by 10-30%
#oncology
#nutrition
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Finally
@asco
daily news highlights a practice changing study from Global South on the last day. Congratulations
@batraatulmd
and team.
#ASCO23
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@anandoncologist
She is the 5th pediatric cancer survivor in the last decade from Cancer Institute who has got admission to a medical college.
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Hakka noodles and chilly paneer for dinner by yours truly. Cooking for others is a great stress buster.
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Doing Surya namsakar is more than just a warm up. A round of 12 Surya Namaskar can leave you exhausted. I have done them and can definitely say they are a full body work out and not just warm up. What do you say
@anandoncologist
@VijayRChari
Yoga is just the warm up you do before a whole good work out
If you have been doing only Yoga, you have been only warming up for a very long time
Yoga is not "therapeutic", it is just "pleasing"
🧘🐍🦆🧘
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Pearls from Scott Howard for high dose Methotrexate.
1. Don't give furosemide.
2. Ensure urine PH maintained at 7.
3. If it drops to 6 then stop MTX, give bicarb and fluid bolus till PH 7.
4. If patient vomits give bicarb and fluid bolus.
5. MTX up to 80 gm given safely
#SIOP2023
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11
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I will be posting about the
#SIOP2023
meeting this week. If you are interested in pediatric oncology stay tuned. If not you can mute me for a while. Why shouldn't anyone be not interested in pediatric oncology? I will mainly focus on research from Global south
#siopambassador
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Our paper got rejected by a journal because the reviewers felt we used a sub standard comparator arm. The NCCN guidelines recommends the comparator arm as a standard of care (level 1) and this is most widely used in LMIC.
Is the NCCN recommending sub standard regimens?
#ASCO23
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Thank you
@DrVijayPatil11
for participating in the journal club on low dose nivolumab paper. Probably the first journal club where the PI was called on the phone to answer questions. The faculty and residents benifitted a lot.
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What more do investigators in LMICs need to do to prove themselves to the world?
Why should I continue doing research?
Why preach in big journals that RCTs should be encouraged in LMICs?
Retrospective studies from HICs get oral presentation but not RCTs in LMICs.
#MedTwitter
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I have been tweeting like a kid who has got a new toy. I will be back in to twitter hibernation once I get back to work this week. So bare with me for few more days. My goal is to highlight the achievements and challenges in LMICs. We need to have a place at the table
#ASCO23
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Weight loss due to cancer cachexia cannot be reversed by increasing calorie intake
#SIOP2023
#SIOPambassador
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I will be tweeting from my account and
@SIOP_Young_LMIC
during
#SIOP2022
.
Some of your twitter time lines are going to get flooded with pediatric oncology news for the next 4 days 🙂.
#siopambassador
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Dear
@MDAndersonNews
the information provided here is partially incorrect. There is no neutropenic diet. Patients need to follow a food safety guidelines diet. Patients with neutropenia need not avoid fruits and vegetables as mentioned. There is enough evidence to support this.
Did you know the foods you eat and how they’re prepared can help reduce your risk of infection?
Learn the ins and outs of a neutropenic diet from clinical dietitian Sheila Vo:
#NeutropenicDiet
#EndCancer
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World, we have arrived.
Congratulations
@DrGauravNarula
@purwarrahul2
and team.
Homegrown CAR-T cells 'cure' 8-year-old's leukemia.
Download the TOI app now:
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Journals that reject recommend to send to another journal that is open access but will cost 5000 dollars. It is like rubbing salt in the wound for a LMIC investigator.
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A lot of people including the amazing
@DrGauravNarula
couldn't make it to
#SIOP2023
due to visa issues. A major barrier for global south to be involved in policy making and sharing their research is that we are denied opportunities to present our work due to visa denials.
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#IndiaAtAsco
#ASCO23
Dr Vanita Noronha TMH presenting her study on patient navigation in lung cancer
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5
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Yes, we can omit dexamethasone for CINV prophylaxis for highly emetogenic chemotherapy. CINV POD (prophylaxis omitting dexamethasone) study results are out.
#ASCO23
OPF (olanzapine, palonosetron and fosaprepitant) should be a standard of care.
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A debate on whether it is ethical to use adapted treatment in low and middle income countries should have representatives from LMICs. All speakers are from High income countries
#globalhealth
Opinions from people working on the ground is important
@DrGauravNarula
@deepakbansaldr1
📢 We invite you to this year's debate at
#SIOP2022
.
🎙️We will debate whether it is ethical to give adapted treatment in low and middle income countries.
Do you want to learn more about the session? - Register and join us ➡️
#ChildhoodCancer
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#IndiaAtAsco
#ASCO23
Dr Rushab Kothari presenting an important study.
OMC is the standard of care in relapsed refractory HN cancer.
This should have been a plenary presentation
@VanitaNoronha
@DrVijayPatil11
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11
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I am sorry if I have flooded your time line with my tweets. There are so many people across the world who are doing amazing and selfless work to improve outcomes in pediatric cancers. Their work needs to highlighted and appreciated.
@WorldSIOP
is a global community.
#SIOP2022
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Wonderful tribute by Dr T G Sagar Director Emeritus Cancer Institute (W.I.A) Chennai for Dr Shanta on her first death anniversary.
@CI_WIA
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Reduction in chemo dose intensity by 25% and adding Rituximab improves survival in pediatric high grade B Non Hodgkins Lymphoma in resource limited settings.
Outcomes comparable to high income countries. A 25% improvement in survival compared to past.
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If I had the money, I would do these studies
1. IMnotPOWER: Immunotherapy versus oral metronomic chemotherapy.
2. LOCKnote: standard dose immunotherapy versus low dose immunotherapy
3. UncheckMate: Repeat all positive immunotherapy trials to ensure they were not flukes.
#ASCO23
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6
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Sex disparity in pediatric cancer care in India.
Hospital and population-based registry data for 30000 pediatric cancer patients.
First of its kind study from India.
❌Bias towards diagnosis in boys
More in North India.
@drsameerbakhshi
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15
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Pediatric cancers are not part of national cancer policy. Less than 20% of children with cancer in India survive compared to 80% in high income countries. The WHO goal of 60% survival worldwide by 2030 can be achieved only if India takes the lead.
@WorldSIOP
@InPOG_
@pho_india
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The Indian Journal of Medical and Pediatric Oncology (IJMPO) is planning a global health issue. I would invite you all to contribute papers to the issue. It could be a commentary, review, policy brief or an original research on global health oncology. Please DM me if interested
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A proud moment when your former fellow (registrar), mentee and friend
@bhaskarlp1
is presenting his Neutropenic diet RCT at
#SIOP2022
#siopambassador
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MASCC ESMO anti-emetic guidelines for highly emetogenic chemotherapy, multi-day chemotherapy, and high dose chemotherapy.
@CancerCareMASCC
@myESMO
#antiemetic
#oncology
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Retrospective studies published in journals but prospective RCT that have not be done before and practise changing not considered worthy of publication.
#AcademicTwitter
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It was a wonderful
#SIOP2023
#SIOPcongress
#SIOPambassador
Lots of great science
Wonderful to see Global Health take the center stage.
All Global Health Network sessions had full attendance.
I will go back in to hibernation till the next conference
Vanakam Namaste
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Some off target benefits of attending
#ASCO23
1. Weight loss due to walking long distance.
2. Improved decision making. Difficult to choose which session to attend.
3. Improved patience. Standing in Starbucks queue for one hour.
4. Opportunity to see oncology superstars.
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#IndiaAtAsco
#ASCO23
Dr Anant from TMH
@AnantRamaswamy
Concurrent capecitabine RT in ca gall bladder
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Saturday night play list
Maroon 5: girl like you.
My heart is a stereo
Coke studio: Hawa Hawa
Vidya Vox: O Sanna
Imagine dragons: believer
Eminem: lose yourself
Green day: basket case
Adele: Hello
What are you listening to
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Even if someone manages to conduct research in LMICs against all the odds, they still have to struggle to get a platform to amplify their research. Most top international journals wouldnt publish their research.
#EditorialBias
#ReviewerBias
#FinancialBias
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Research from India can impact the whole world. An amazing study on low dose immunotherapy from TMH. This is the real game changer and breakthrough treatment. Congratulations
@DrVijayPatil11
@VanitaNoronha
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David vs Goliath
@KBommannan
presenting at
#SIOP2023
in the ALL session. The other talks were from COG and Chinese leukemia group. A proud moment for
@CI_WIA
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#IndiaAtAsco
#ASCO23
Dr Navneet Singh from PGI Chandigarh presenting on polymorphism is lung cancer
@ns_chd
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A big issue for access to cancer medicine in LMICs is that many private hospitals profit from medicines. The purchase price of hospitals is sometime 20% of the price the patient pays. It's a free market, if government intervenes then many hospitals will shut down.
#ASCO23
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Does IVIG prophylaxis reduce infections in pediatric patients with ALL.
Phase 3 RCT
IVIG once in 3 weeks
No benefit with use of IVIG for reducing infections in induction and consolidation but beneficial in maintenance.
No impact on survival and relapse
#SIOP2023
#SIOPambassador
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It was a great honor and privilege to meet
@Winette_vdGraaf
Eortc president at
#ASCO23
. Looking forward to EORTC and India collaborations.
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Fosaprepitant is inferior to aprepitant for control of acute chemotherapy induced vomiting in pediatric patients receiving highly emetogenic chemotherapy. Presented by
@drsameerbakhshi
#SIOP2023
#SIOPambassador
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6
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Blina prior to CD19 CART.
Those who didn't respond to blina did worse. Those who had CR with blina and then relapsed has similar outcome to those who didn't receive blina. MLL gene doesn't respond to blina.
#SIOP2023
#SIOPambassador
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What do you do in resource limited settings, where it is a challenge to treat patients with cancer.
#SIOP2022
#siopambassador
0
5
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T ALL is a heterogeneous disease there are 15 different genomic subtypes
Majority of alteration in T ALL is in non coding region. Whole genome sequencing required.
#SIOP2023
#SIOPambassador
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"Vaango" (Tamil for please come) to poster board 480 and 495 today between 1.15 pm and 4.15 pm to see our small contributions to science that will hopefully improve patient care.
#ASCO23
#supportivecare
.
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The
#siopambassador
. What a wonderful bunch of diverse individuals.
@venkymd
is jumping in air to appear in the photo.
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Inviting Oncology trainees and recently graduated (less than 5 years since completion of fellowship) to join the SIOP Global Health Young (LMIC) Working Group. Let's encourage research and participation from LMICs
@WorldSIOP
@youngsiop
@AsiaSiop
@StJude
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This study is from your center. showing no benefit of a neutropenic diet
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CART in high risk cytogenetics.
No difference in survival due to cytogenetics risk factors.
CART overcomes poor prognosis cytogenetics in ALL
#SIOP2023
#SIOPambassador
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adding CRSF. Watch out for the collaboration. They are going to bring out high impact studies
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#IndiaAtAsco
#ASCO23
Dr Aditya TMH Mumbai presenting on neoadjuvant chemotherapy in oral cancer
1
6
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Congratulations
@lisamforce
and team for this important publication in
@TheLancetOncol
on the Global Burden of adolescent and young adult cancer. It was a great learning experience for me to be involved with this paper.
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2
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Poster session at
#ASCO23
are like school or college. There is the popular cool person around whom everyone likes to hang around. Then there is the shy introvert person who yearns that someone will come and talk to them, briefly meeting eyes with you when you walk past them.
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Carlos Rodriquez Galindo. A legend, an inspiration, a great leader and a fantastic person receiving the City Award.
@stjudegraduate
#SIOP2022
#siopambassador
0
6
23
HDMTX administered without serum monitoring by extending hydration, leucovorin rescue (6 doses) and serum creatinine.
@deepakbansaldr1
Urine PH not monitored. 17% had increase in create by 1.25 times. No dialysis. Mortality 1% due to sepsis.
#SIOP2023
#SIOPambassador
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