August , 2017
Personalised cancer treatment- revolutionising the cancer scenario in India
15:09 pm

Dr. Vijay Agarwal

In India, approximately 15 lakh people are thought to be living with cancer and out of every one lakh population, an estimated 150 new people will develop cancer. The incidence is expected

to rise by 7% to 8% annually. The major risk factors for cancer in India are tobacco, alcohol, and obesity. Unfortunately, only 20% of the people are brought to cancer hospitals with early stage cancers whereas the majority is consulted when the disease has already progressed to advanced stages.

Cancer treatment scenario has always been domi-nated by surgery, chemotherapy, and radiotherapy techniques since it was understood that all cancers, deriving from the same site were biologically similar and were classified based on microscopic diagnosis, size and presence/absence of regional nodes or distant metastases, as well as other features that may be observed on examining the tumour sample. These treatment procedures, particularly chemotherapy and radiotherapy, have side effects, where it kills the cancer cells that divide rapidly, but also heavily affects healthy cells, resulting in partial efficacy and unwanted side effects.

The approach of cancer treatment has transformed over time, with innovation and scientific advancements resulting in improved outcomes. Personalised cancer treatment is being adopted widely by oncologists and cancer care hospitals. Personalised cancer management is the practice of treating cancers by understanding the molecular characteristics of the individual cancer patients. Patients are prescribed a personalised course of treatment post rigorous diagnosis which reveals the criticality and nature, traits of the diseases with more individualistic insights. We are developing research, innovations and progressively adapting towards personalised oncology and focusing on the right kind of treatment since it depends on patients’ personal medical history, their tumour status and respective genomic or molecular composition.

Some of the breakthroughs in personalised cancer treatment are targeted therapy and immunotherapy. In targeted therapy, the drugs act against molecular targets in cancer cells. These drugs are formulated in laboratories and designed to have an effect on specific receptors of the cancer cells. This is used very commonly in breast, lung, colon, kidney, thyroid and head and neck cancers to name a few. Patients undergo genomic evaluation of their tumour type and based on the results, specific drugs are selected and offered to patients. For example, all patients with lung adenocarcinoma undergo molecular profiling for various targets such as EGFR, ALK, ROS, MET, KRAS, HER2, PDL1 etc. and if any of these targets are identified, then specific drugs targeting the defects are offered to our patients resulting in significantly better outcomes and quality of life compared to giving only chemotherapy.

It is also important to identify certain molecular markers whose presence impart resistance to some of the targeted therapies. Identification of these resistant biomarkers help us to avoid prescribing drugs that are not effective, thereby reducing the side effects and saving time and money for them. For example in colon cancers, identification of gene defects such as KRAS or NRAS make them resistant to certain targeted therapies such as Cetuximab and Panitumumab because giving these drugs to the patients with the gene defects are detrimental to their health and survival.

Immunotherapy is another modality towards personalised therapy developed and undergoing research. Various types of immunotherapy exists such as PD1 inhibitors, activated T cell lymphocyte infusion, dendritic cell vaccination etc. and are now used in a variety of cancers such as lung, head and neck, melanoma, bladder, renal cancers. Immunotherapy stimulates the body’s own immune system to fight the cancer cells. We can now check for specific markers that can identify certain patients who are more likely to respond to immunotherapy drugs such as PD1 inhibitors and offer these drugs to those patients.

At HCG, all patients with advanced cancers are offered genomic testing and molecular profiling as a part of standard diagnostic work up. If any targetable defects are identified, then they are offered targeted therapy or immunotherapy as appropriate. All patients are discussed in the multidisciplinary tumour board meetings with medical oncologists, radiation oncologist, surgical oncologist, pa-thologist, geneticists, molecular biologist, radiologist and psycho-oncologist prior to any decision making. This has helped us in ensuring that our patient outcomes are amongst the best in the world. With adoption of new age therapies, there has been a sig-nificant advance in the treatment of cancer, thereby increasing in survival rates and offering people with improved quality of life post treatment.

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