Advancement in cancer treatment

February 4 marks World Cancer Day, Dr SVSS Prasad, Sr. Consultant Medical Oncologist, Apollo Cancer Hospital, discusses the latest medical developments

The advances that are taking place in cancer-related treatments are mainly newer targeted therapies. As newer molecular targets are identified in various cancers, like new 'mutations in genes' , or the enzymes or proteins promoting cancer that are the effects of these mutated genes , or the newer pathways that are activated in cancer development are identified,  newer drugs that target these molecular targets are developed. These improve the survival of cancer patients. In 2016 eight new cancer treatments were approved for use. Another advance is finding the improved effectiveness of combination of these targeted therapies with existing chemotherapeutic agents. Midostaurin, which targets FLT3, a gene mutation in some cases of Acute Myeloid Leukemia (AML), is combined with standard chemotherapy for AML. This showed significant improvement in outcomes of these patients, who hitherto had poorer survivals. Here we administer the different types of drugs sequentially to a patient at the same sitting.   'Antibody Drug Conjugates' (ADCs) are another new class of drugs - here antibody is chemically linked to a powerful cancer drug. Inotuzumab ozogamicin in adult Acut Lymphoblastic Leukemia (ALL) who don't respond to standard treatment is one such new treatment. IMGN853 is another such ADC being developed for Ovarian Cancer.  Another newer modality is immunotherapy, already in use in lung cancer and some other cancers - discovery of increasing number of newer immunotherapies and increasing number of cancers in whom they are useful - is the order of the day. These immunotherapies are also being combined with chemotherapy with improved results.

OTHER DEVELOPMENTS

Research is on to develop a new drug in Britain, that reactivates a new protein called 'p53' and causes cancer cells to die.

Research is also on in Spain to see how fats in diet might contribute to the spread of cancer in oral, skin and breast cancer.

Research is on in London to investigate how CRISPR gene-editing could be used to bolster a personal immune system in the fight against cancer. 

Laparoscopic surgery and robotic surgery in various cancers, their increasing usage and benefits and identification of their pitfalls in some indications is an area of continuous research in surgical oncology.

In Radiotherapy continuous improvements are taking place in delivering precision radiotherapy, avoiding radiation to normal tissues and in delivery of  higher doses to the cancer tissue.

In India, we have developed the capacity to incoporate these newer developments in treatment of our patients on par with the Western World - be it drugs, infrastructure or equipment. Basic research in India has a long way to go.

THREAT

Biggest threat to cancer research

In India: Financial and the political will to develop research which can show results only after a  long time and not immediately.

PUBLIC UNDERSTANDING 

Through public education in a scientific and unbaised way. Misleading propaganda is to be avoided at all costs. Yes, our medical fraternity and to a large extent the educated middle classes are well informed, thanks to the internet/social media. Channelising the information properly and correctly to the larger populace is media's responsibility. Education on prevention, early detection and good life style is of utmost importance.

Spreading the message that "together we can" is important.

BREAKTHROUGHS

There is no breakthrough that will change things forever. Every breakthrough improves the prospect of a good outcome, but nature finds ways to circumvent the breakthrough. Therefore efforts to improve things is a matter to be termed "continuous".

For Appointment :  Dr SVSS Prasad, Sr. Consultant Medical Oncologist, Apollo Cancer Hospital,