Revolutionising Cancer Treatment

Precision medicine, which hails as the cornerstone of modern cancer treatment, is gaining momentum across India's leading healthcare institutions. Experts from various specialities underscore its potential to revolutionise patient care, offering tailored therapies that target individual genetic profiles.

Aparna Dhar, Director of Oncology (Precision Oncology and Genetics), Max Healthcare, Delhi, said that precision medicine actually means the right treatment to the right patient at the right time. “There was a time when someone who had lung cancer had to undergo chemotherapy and radiation but with the present oncology techniques, we understand what is the nature of the tumour, and the genetic behaviour of the cancer. Understanding this biology helps us understand how to treat the patient,” she added.

She also went on to say that sometimes it is better to treat cancer with traditional chemotherapy because it may be something that will work best in that situation.

Precision therapy

Elaborating on the process of precision therapy Dhar said, “We take samples of the cancer cell and do profiling of that cancer cell. Then we identify what are the changes that have come up in certain genes and what genetic errors have come. If a cancer is hereditary then it might be due to genetic behaviour.” She stated that they try to identify a general structure which tends to put that individual at a slightly higher risk of cancer. She feels that if they were able to find out what kind of specific treatment is required, that is what they call precision medicine.

Elucidating on the example of precision medicine, Anupam Sachdeva, Chairman, Department of Pediatrics and Director Pediatric, Hemato-Oncology and Bone Marrow Transplantation, Sir Ganga Ram Hospital, Delhi, said that a simple example of precision medicine is the treatment of Chronic Myeloid Leukaemia (CML) where the gene called BCR-ABL is treated using a series of drugs, one of which is Imatinib. “In the year 1992-93, Imitinab was not available and the medicine that was used was priced at around Rs 1.25 lakh per year. The new medicines have benefitted in the way that now we can get blood cancer in check for many years without a transplant,” added Sachdeva.

Sachdeva further emphasised that transplants were one of the most important reasons for morbidity and mortality at that time but it has significantly reduced and blood transplant is implemented in only those cases where these medicines are not helpful.

Relation between cancer and genes

Shyam Aggarwal, Medical Oncology, Sir Ganga Ram Hospital, Delhi said, “Cancer is a disease related to genes and today we are fortunate that we have the technology which can do profiling of genes. In merely 10 days we can find out which genetic sequence has a problem.”

Aggarwal further mentioned, “As pointed out by  Sachdeva, some cancers can be treated by a single medicine but for the cancer cases that occur in majority are liver cancer, kidney cancer etc. There are hundreds of genes which have problems and all of these genes are the drivers of these kinds of cancer.” He emphasised that it is easily identifiable that which are the genes that have

problems but the primary issue is the medicines that have been developed, are for a limited number of genes.

Aggarwal also highlighted some other issues in targeted therapy by stating, “Cancer cells also perform genetic mutation therefore after one year or so the cancer outsmarts the medicine. These changes in the cancer force us to develop the second and third generation of drugs.” He also added that there are five ways from which they are treating cancer, namely: Operation, Radiation, Chemotherapy, Targeted therapy and Immunotherapy.

Genome sequencing

Sarjana Dutt, Lab Director- National Reference Lab, Head of Molecular Biology and Cytogenetics, Pathkind Diagnostics, Gurugram said, “The entire story and life cycle of cancer revolves around genetic mutations. Now, we have transformed from genetics to genomics and we scan the entire genome of that specific individual and then identify which are the genomes that are responsible for causing that cancer, particularly to that individual.”

Dutt further highlighted that the cost of genome sequencing has come down from a staggering USD 100 million in the year 2001 to merely USD 400 in the year 2024 and also stated that “Now it is not important to do the entire genome sequencing to identify the genes responsible for causing cancer, and the cost required to identify the specific genes causing cancer is around USD 100 to 150 in India,”

Targeted therapy and genomics

Rahul Bhargava, Principal Director and Chief Haematology, Fortis Memorial Research Centre, Gurgaon said, “Targeted therapy has been a prominent player in curing blood cancer with a success rate of 70 per cent. Precision therapy can decrease the cost of treatment by around three lakhs. Now is the time when we want to do more diagnosis and less treatment because fewer medicines can give better outcomes.”

Moving on and mentioning the importance of genomics he said that, “Genomics is going to play a huge part in preventing the diseases which come back. Genomics has a preventive aspect also where it can prevent diseases like Thalassemia, Haemophilia, Spinal Muscle Atrophy and Mucopolysaccharidoses (MPSs).”

Rajendra Toprani, Director - Head and Neck Surgical Oncology, HCG Cancer Centre, Ahmedabad said, “Unfortunately, the major cause for oral cancer is tobacco, areca nut and alcohol. The key to curing head and neck cancer is to diagnose it at an early stage.” He feels that organ preservation leads to an improved quality of life. According to him as far as precision medicines are concerned, they have a very important role to play in Medullary Thyroid Cancer.

The insights were shared during the 3rd edition of BW Healthcare World's Oncology Summit, highlighting the significance of precision medicine in advancing cancer care in India.

Sheikh Rishad

BW Reporters The author is a Trainee Correspondent with BW Businessworld