Kumar Prabhash

Background: Pneumococcal disease imposes a substantial public health burden in India, particularly among older adults and individuals with chronic or immunocompromising conditions. Although the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine are available, the emergence of non-PCV13 serotypes has highlighted the need for broader serotype coverage. The approval of the 20-valent pneumococcal conjugate vaccine (PCV20) offers expanded serotype coverage and the potential to simplify adult vaccination strategies. Methods: A multidisciplinary expert panel convened to develop evidence-informed expert opinions on PCV20 use in adults. A narrative literature review (2010–2025), a structured pre-meeting web-based survey, and structured discussions using the Nominal Group Technique were conducted. Expert opinions were refined, reviewed, and approved by all panel members. Results: Based on the available evidence and expert deliberations, the panel supported single-dose PCV20 for adults aged ≥50 years and at-risk individuals aged 18–49 years. The panel also provided specialty-specific recommendations to facilitate the implementation of PCV20 in routine clinical practice across diverse adult populations in India. Conclusions: These multidisciplinary expert opinions provide practical guidance for PCV20 use in Indian adults and are intended to complement, not replace, the formal national recommendations and to support informed clinical decision-making for adult pneumococcal vaccination in India, while acknowledging remaining uncertainty regarding effectiveness, implementation, affordability, and the need for further India-specific evidence.

Background: This retrospective study introduces imaging inner tumor margin patterns (iITMP) and evaluates their correlation with pathological Worst pattern of invasion (WPOI) in oral tongue squamous cell carcinoma (OTSCC). Associations of iITMP with pathological primary tumor category (pT), histologic grade, perineural invasion (PNI), nodal metastasis, and extranodal extension (ENE) were assessed. Correlations between imaging depth of invasion (iDOI) and pathological DOI (pDOI), and between imaging primary tumor (iT) and pT, PNI, and ENE were evaluated. Methods: Baseline magnetic resonance imaging (MRI) from January 2021 to December 2022 of 224 upfront-operated OTSCC patients was reviewed by two blinded radiologists using contrast-enhanced thin-slice. iITMP (types 1–3) were classified based on inner tumor margin morphology. iDOI was measured after excluding peritumoral hyperenhancement. Correlation between categorical and continuous variables were assessed using Kappa statistics and Spearman’s test respectively. Associations between categorical variables were analyzed using Fisher’s exact or Pearson’s chi-squared tests. Univariable and multivariable analyses were additionally performed. Results: The mean patient age was 47 ± 11 years. Substantial agreement was observed between iITMP and WPOI, and between iT and pT. iDOI strongly correlated with pDOI. iITMP was significantly associated with pT, irregular (iITMP2) and infiltrative (iITMP3) margins were associated with PNI only on univariate analysis, while iITMP was not an independent predictor on multivariable analysis. iT significantly correlated with PNI and ENE. Conclusions: iITMP strongly correlate with WPOI and is substantially associated with pT categories. iT categories show significant association with PNI and ENE. Therefore, iITMP and iT may serve as potential imaging biomarkers of adverse histopathological features in OTSCC.

Background: Adjuvant chemotherapy is recommended for high-risk penile squamous cell carcinoma (SCC) metastatic to lymph nodes based on retrospective data, but no randomized trials have been conducted. We compared 5-fluorouracil (5-FU)-platinum with paclitaxel-platinum in this setting. Methods: In this open-label, randomized trial at an Indian tertiary cancer center, men 1 inguinal nodes, or ≥4 cm node) were assigned 1:1 to four 3-weekly cycles of 5-FU-platinum or paclitaxel-platinum, followed by cisplatin-based chemoradiotherapy. Primary endpoint was disease-free survival (DFS). Secondary endpoints were overall survival (OS), toxicity, and quality-of-life (QoL). Results: Between 2017 and 2024, 49 patients were randomized (5-FU-platinum: 25, paclitaxel-platinum: 24). At a median follow-up of 69 months, median DFS was 12.4 months (95% CI = 3.38 to not reached [NR]) vs 19.6 months (95% CI = 5.82 to NR) (HR = 1.16; 95% CI = 0.55 to 2.45; P = .686), and median OS was 21.3 vs 36.7 months (HR = 1.13; 95% CI = 0.52 to 2.44; P = .754) for 5-FU-platinum and paclitaxel-platinum, respectively. Grade ≥3 toxicities occurred in 77.3% vs 40.9% (P = .014), grade ≥3 hematologic toxicities in 54.5% vs 4.5% (P < .001), and hospitalization for toxicity in 45.5% vs 9.1% (P = .016). Completion of all planned cycles was higher with paclitaxel-platinum (83.3% vs 48%; P = .009). QoL and sexual health were similar between the 2 treatment arms. Conclusions: Adjuvant paclitaxel-platinum was associated with improved tolerability compared with fluorouracil-platinum in high-risk node-positive penile cancer and warrants further evaluation in larger multicenter studies. Early termination precluded definitive efficacy comparisons. Trial registration: Clinical Trials Registry of India (CTRI/2016/12/007567).