Development of Video follows up

This work was done by me in collaboration with Professor Jalali. Gliomas are the commonest primary brain malignancies seen in adults. Many of these patients have significant physical or cognitive dysfunction and need significant psychosocial support from the caregiving team. Getting these patients to hospitals is difficult and hence we performed this study to study whether video follow-ups can replace clinical follow-up. This was a randomised study and it showed that video follow up can substitute clinical follow up. This study was published in 2018 and was a great boon during the COVID time.

Development of mebendazole in glioma

Relapsed high-grade glioma has dismal outcomes. Mebendazole has shown promising activity against glioma in in-vitro and in-vivo studies. Hence, we undertook a phase 1 study to repurpose mebendazole in the treatment of glioblastoma. We recommended phase 2 dose of mebendazole is 1600 mg TDS with temozolomide and temozolomide-radiation combination while the dose of 800 mg TDS needs to be used with single-agent CCNU.

Key takeaway: Conceptualised and proved effectiveness of a repurposed, easily available anti-parasitic medicine in treating a high grade type of brain cancer ie glioma.

Development of bevacizumab

Original bevacizumab is costly. Hence, we worked on low-dose bevacizumab and on generic bevacizumab. Both these publications have helped in establishing the role of generic and low-dose bevacizumab.

Development of brain metastasis clinic

Management of brain metastasis is a complex multidisciplinary venture. Hence, we started a multidisciplinary brain metastasis clinic for the opinion on difficult brain metastasis cases. This was the review of the impact of this clinic on treatment decisions. The brain metastasis clinic (BMC) was started in April 2018 and meets once a week. Data of patients discussed between 27th April 2018 and 28th June 2019 were included for this analysis.The treatment plan was changed in 46 patients (46.5%). The intent of treatment was changed from palliative to curative in 5%. Change in the treatment plan with respect to surgery in 9.1%, radiation in 37.4%, chemotherapy in15.2%, targeted therapy in 22.9% and intrathecal in 6.1% patients, respectively. The compliance with the BMC decision in patients in whom it was changed was 84.8% (39, n = 46).

Key takeaway: Showed how a multidisciplinary structure to discuss complex brain metastasis cases can impact and improve care.