Rearranged during transfection (RET) alteration promotes oncogenesis in a few cancers. RET mutation positivity is seen in approximately 70% of medullary thyroid cancers, around 30% of differentiated papillary thyroid cancers, and 1-2% of non-small-cell lung cancers (NSCLC). To write this narrative drug review, we searched various websites like the United States Food and Drug Administration, PubMed, Google Scholar, UpToDate, and recently published papers in various international conferences using the search terms “RET,” “RET alteration,” “Retevmo,” “RET inhibitors,” and “selpercatinib.” We shortlisted 31 articles published between January 1980 and January 2024. We discuss the history, mechanism of action, resistance, pharmacodynamics, pharmacokinetics, dosing, toxicity, pivotal trials, and indications of selpercatinib. Selective RET inhibitors like selpercatinib are indicated in the treatment of RET-altered NSCLC and thyroid cancer.

In laryngeal cancer, the goal of treatment is to achieve maximum cure and preserve function of the larynx with good voice quality. In early disease, transoral laser microsurgery is the preferred choice of treatment. An option for treatment of carcinoma in situ is radiotherapy (RT). In locally advanced laryngeal carcinoma, concurrent chemoradiotherapy (CTRT) is an option. Induction therapy with docetaxel, cisplatin, and 5-flourouracil (TPF), followed by definitive RT or definitive CTRT can be one of the organ preservation approaches for patients undergoing total laryngectomy. For resectable locally advanced disease (T3, N0-3), surgery (laryngectomy with thyroidectomy, ipsilateral or bilateral neck dissection, and pretracheal and ipsilateral paratracheal lymph node dissection) with RT or CTRT should be considered.

Site-specific imaging for head-and-neck cancers is essential to convey the relevant information on the radiological tumor stage accurately to the surgeons/treating physicians, thus helping them to decide upon the management. Additionally, the role of imaging cannot be overemphasized for neck screening for nodes and metastasis. Certain crucial structures at each head-and-neck site elude direct visualization on clinical examination; hence, it is pertinent to be aware of these structures, the involvement of which, on imaging, can change the management plan from curative to palliative intent. Though international guidelines exist, there have been no dedicated imaging guidelines for head-and-neck cancers in India. We propose site-specific pre-treatment imaging guidelines for various head-and-neck cancers and neck nodes, including the choice of imaging modalities for each site, protocols, and management implications of crucial structure involvement at each site. By proposing these recommendations, we intend to standardize head-and-neck imaging throughout the country.

Background: Older adults often have chronic diseases for which they receive multiple drugs, which may be potentially inappropriate. Objectives: We aimed to describe the potentially inappropriate medications (PIMs) leading to adverse drug events (ADEs) in older patients with cancer. Our secondary objectives were to evaluate the association of nutrition, cognition, and frailty with PIM-related ADEs and to assess the impact of PIM-related ADEs on overall survival (OS). We also investigated the cut-off for defining polypharmacy as related to ADEs. Materials and Methods: This was a retrospective observational study on patients with cancer aged 60 years and over who were assessed in the geriatric oncology clinic at the Tata Memorial Hospital (Mumbai, India) from June 2018 to August 2022. Medications, PIM assessment, nutrition (assessed by Mini Nutritional Assessment [MNA]), cognition (assessed by Mini Mental State Examination [MMSE] and Hindi Mental State Examination), and frailty (assessed by the Clinical Frailty Scale [CFS]) were extracted from the geriatric oncology clinic database. PIMs were identified using the Beers criteria, European Union-7 (EU[7])-PIM, Screening Tool of Older person’s Prescriptions/Screening tool to Alert to Right Treatment (STOPP/START), Fit fOR The Aged (FORTA), and PRISCUS list. Results: In total, 1472 patients were assessed in the geriatric oncology clinic, of which 823 (55.9%) were enrolled in the study. There were 1287 PIMs detected in 823 patients, of which 431 (33.5%) led to ADEs and 856 (66.5%) did not. Proton pump inhibitors and tramadol were the most common PIMs identified. ADEs were noted in 54 (14.7%) patients on proton pump inhibitors and in 145 (61.1%) patients on tramadol. ADEs were significantly associated with malnutrition, lower cognition, and frailty. The median MNA score in patients without and with ADEs was 20.5 (interquartile range [IQR], 17.5-24.0) and 19.5 (IQR, 15.5–23.5), respectively; P, 0.001. The median MMSE score for the patients without and with ADEs was 28 (IQR, 26-29) and 27 (IQR: 25-29), respectively; P, 0.001. The median CFS scores for the patients without and with ADEs were 3 (IQR, 2-4) and 4 (IQR, 3-5), respectively; P < 0.001. The median OS in patients without and with ADEs was 13.1 months (95% confidence interval [CI], 10.64-17.87) and 10.2 months (95% CI, 8.80-12.85), respectively; P, 0.002. The optimal cut-off for polypharmacy leading to ADEs was 4.5 medications. Conclusions: There is a dire need to recognize and appropriately manage PIMs in older patients with cancer as PIM-related toxicities may negatively impact survival. Monitoring PIMs and following the recommendations to optimize the dose, avoid the drug, and find alternatives may improve the oncologic outcomes. Future studies should focus on adding a control group of patients not on PIMs, following up on PIM after recommendations, and investigating the impact of these recommendations on oncologic outcomes (Clinical Trials Registry-India: CTRI/2020/04/024675).

Head-and-neck cancer (HNC), a malignant tumor of the upper aerodigestive tract, is the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines and recommendations for the management of HNCs, these may not be appropriate for the Indian scenario. In order to discuss current practices, and latest developments, and to come to a consensus on management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical, and radiation oncologists, and dentists) came together. A review of literature from medical databases (PubMed, Google Scholar) was conducted to provide the best possible evidence, which was reviewed by experts in 2019 when the first consensus guidelines were developed. These guidelines were published in the Indian Journal of Cancer in February 2020. To update these guidelines regularly, the experts reconvened on July 27, 2022, and updated the recommendations for all subsites based on the recent evidence.

Background: Head-and-neck cancers (HNCs) originate at multiple subsites with varying epidemiology and clinical profiles across India. Objectives: This study aimed to explore the demographic and clinico-epidemiologic profiles of patients with HNC at our institution. Materials and Methods: This retrospective observational study was conducted on the case records of all patients with HNC who were registered between January 2018 and December 2020 at the Department of Radiation Oncology of Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, a comprehensive cancer center in rural Northern Haryana, India. Results: We enrolled 516 patients in the study. The mean age was 56 years (standard deviation (SD) 12.6), and the male-to-female ratio was 8.6:1. Smoking was reported by 413 (80%) patients, and smokeless tobacco use was reported by only 74 (14.3%) patients. Oropharyngeal cancer (178, 34.5%) was the most common site observed, and the base of tongue (112, 21.7%) was the most common subsite; oral cavity cancer was the second most common primary site, noted in 140 (27.1%) patients. This was contrary to global and national data, wherein oral cavity cancers are the most common. Most patients (226, 43.8%) presented with locally advanced disease, that is, Stage IVA. Conclusion: Oropharyngeal cancers are found in higher proportion when compared to oral cavity cancers in this belt of Northern Haryana and Northwestern Uttar Pradesh, owing perhaps to a higher level of smoking than tobacco chewing.