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Immunotherapy is the ray of hope for cancer warriors across India, Health News, ET HealthWorld

By Dr Sanchayan Mandal

Last October, I met Malati Sarkar (name changed), who walked into my chamber with her husband and seven-year-old son. She has been detected with an advanced (metastasis) stage of breast carcinoma. Otherwise, a happy family of three with a secure job, she didn’t know what to do.

A few weeks later, Mrs. Sarkar responded positively to the treatment. What I tried on her was immunotherapy, the most advanced treatment in cancer care today. And four months later, she is back to her stable form. Commuting daily to work, cooking meals for the family, and keeping the family chemistry intact. Not only did the signs of recovery begin, but the tumor has been shrinking.

What is immunotherapy

Our body’s immune system is formed by a complex network of cells and organs that help defend against antigens like bacteria, viruses, toxins, and allergens. These antigens trigger an immediate reaction when in contact with our skin or mucous membranes. This is the same principle applied in cancer treatment now. Under normal circumstances, the natural immune system cannot detect cancer as a foreign invader. This happens because cancer cells aren’t like external invaders that will trigger responses. Instead, cancer cells are ordinary body cells with mutated behavior. And this is precisely where immunotherapy helps. With regular doses, immunotherapy makes the body’s immune system identify cancer cells and alerts them to act against them.

Immunotherapy is quite effective because it kills cancer cells and prolongs the patient’s life expectancy. And that is where the success story of immunotherapy is established.

Which organ cancers respond to immunotherapy?

While the first immunotherapy drug came into the market in the USA in 2011, being relatively new, many trials are ongoing. At present, immunotherapy can be treated to cure bladder cancer, breast cancer, Cervical cancer, Colorectal cancer, Esophageal cancer, Head and neck cancer, Kidney cancer, Liver cancer, Lung cancer, Lymphoma (Hodgkin’s) Melanoma, Merkel cell carcinoma, Prostate cancer and Squamous cell carcinoma of the skin.

Treatment Procedure

Depending on the cancer type and stage, the doses are decided. In India, immunotherapy is administered through IV only. Immunotherapy can be administered either to admitted patients or at OPDs. For the former, you don’t need an overnight stay. However, for the first few doses, we recommend patients stay admitted to understand if there are any side effects.

What are the side effects?

In India, we think cancer drug treatment always means losing hair and severe side effects. Trust me, of more than 7000 patients I have administered immunotherapy to date; there have rarely been severe reactions. Most side effects are limited to mild nausea, dizziness and chills. Swelling and cramps are expected if we are dealing with cancer within muscles. Immunotherapy tends to lower blood counts at times. But with improved palliative care, we prescribe the patients with advanced supportive drugs that minimize the side effects. It is always advisable to consult your healthcare provider regarding the side effects. But when you are winning a war, a little pain is bearable.

Is immunotherapy better than chemotherapy?

Unlike immunotherapy, chemotherapy uses drugs to target and kill fast-growing cells. While immunotherapy and chemotherapy are popular in India now, the former is limited to a few types of cancer and requires specialisation. Chemotherapy being common is administered across most hospitals, while immunotherapy needs special training among doctors. If we talk about the side effects of the treatment, chemotherapy needs some premedication, especially steroids, to prevent anaphylaxis or allergic reaction. But in the case of immunotherapy, steroids are avoided. Steroids decrease the efficacy of immunotherapy. Although a recent study shows a permissible dose of steroids in case it is needed and in case of Immunotherapy toxicities. Also, chemotherapy needs to be administered till the last day in case of advanced stages, while immunotherapy can be given maximum for two years. In most cases, results start showing earlier.

Cost of immunotherapy

When deciding on cancer treatment, medical oncologists go through tremendous challenges in balancing the efficacy of the treatment and affordability. Also, we see many patients, particularly in the eastern states where health insurance isn’t standard. The treatment scope often becomes limited in these cases as we cannot prescribe the best treatments.

With patents in the USA, immunotherapy costs more than conventional treatments. The price starts from Rs 1 lakh for each session. Keeping the cost in mind, I personally have collaborated with various non-profits who can provide funds for such expensive treatments.

A few health insurance companies provide immunotherapy coverage so it is advisable for everyone to have health insurance. Also, government hospitals can consider subsidizing immunotherapy treatments to make treatments affordable.

To conclude, immunotherapy is the answer to cancer today. I urge the doctor fraternity to step in together to make the treatment accessible and affordable to the millions of cancer patients in our country.

Dr Sanchayan Mandal, Medical Oncology consultant, HCG EKO Cancer CenterKolkata

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. shall not be responsible for any damage caused to any person / organization directly or indirectly)

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