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Widespread impact on cancer care requires expensive tests, drugs becoming easily accessible Health News ET HealthWorld

Dr Rajendra A Badwedirector, Tata Memorial Center in an exclusive interaction with ETHealthworld’s Prathiba Raju on World Cancer Day informed that precise gene editing techniques, next generation of immune treatments involve sophisticated drugs like bispecific antibodies, drug-antibody conjugates and cellular immunotherapies like CAR-T cells, NK cells and others. Such treatments promise to provide control or even cures for hitherto incurable cancers in advanced stages. However, he said that these expensive tests and drugs can have a widespread impact on cancer care only when they become more easily accessible to patients.

What are the setbacks in cancer treatment due to COVID-19 and how can these gaps be bridged?

The initial part of the COVID-19 pandemic was challenging for patients with cancer because they found it difficult to reach their hospital to get diagnosed and treated. A study done with the National Cancer Grid of close to 40 major cancer centers showed that in the first three months of the pandemic including the lockdown, there were reductions in volumes of patients reaching these hospitals to the tune of 50-60 per cent. However, after the lockdown was lifted, patients started coming back to hospitals for treatment. Within a year of the pandemic starting, we were back to the same volumes that we had before the pandemic. Thanks to the dedication of all our staff, we were able to provide uninterrupted cancer care while also treating patients with cancer who developed COVID-19 from all over the state.

How is the lack of generic options in immunotherapy or targeted therapy agents making cancer treatment unaffordable? What kind of changes are necessary when it comes to cancer drugs?

Immunotherapy has indications across 20 cancer sites, with the indication in curative (n=6) and non-curative settings (n=20). The impact of these molecules varies from modest to huge depending on the cancer type. For example in lung cancer, when immunotherapy is given before surgery it leads to a nearly 20 percent absolute decrease in the risk of the disease coming back (55 percent decreases to 37 percent) within two years. Similarly, when this drug is given for lung cancer after curative chemoradiation it improved the chances of survival from 55.6 per cent to 66.3 per cent. In the advanced stage of head and neck and melanoma, we have started seeing almost one-fourth of patients surviving long term where average life used to be around 8-10 months. These drugs unfortunately either are too costly or are not available in India. Hence less than 3 percent of our patients can take it.

Similarly, there are multiple types of targeted therapies like monoclonal antibodies, tyrosine kinase inhibitors, angiogenesis inhibitors, etc. These have indications nearly across many cancer sites both in curative and non-curative settings. Their impact is enormous on many tumors. For example in ALK mutated NSCLC a type of lung cancer with chemotherapy the average life span is below one year. However with appropriate targeted therapy today it is beyond six years. There is limited access to these newer drugs.

Hence we require some solutions. Having an affordable generic is one solution, allowing (and funding) the development of drugs in Indian institutes will help to bring down the cost, allowing (and funding) investigators in India to do academic studies to innovate low-cost schedules, propagating and making Favorable environment (providing funding, manpower, allowing patients on government & insurance schemes to participate in studies, separate rules for investigator-initiated or academic studies) for early drug development in India will go a long way in having ‘Made in India’ immunotherapies. Examples of such successful efforts are in India, for example, the first attempt to develop low-dose immunotherapy in the world was done in India at Tata Memorial Hospital. Hence support and reciprocity of such efforts will change the scenario in India.

How are technologies artificial intelligence (AI), machine learning (ML) and other digital technologies helping in cancer care be its diagnosis treatment and prevention?

Digital technologies including AI and ML have been tried to improve cancer care in various aspects of diagnosis and treatment. Tools are being developed which use pattern recognition of X-ray images and pathology slides to be able to guide diagnosis. Tata Hospital has worked with a company called Navya to enable evidence-based treatment based on available guidelines and AI. The National Cancer Grid has recently signed an MoU with the foundation to set up the NCG Koita center for digital oncology to unify all our technological efforts in digital health to enable improved access, availability of data, and better cancer care for our patients.

How will genomic profiling, gene editing technologies evolution, next generation of immunotherapies and CAR-T cell therapies help in revolutionizing cancer care in future?

Genomic (and other ‘omics’ like proteomics, metabolomics, etc) profiling has enhanced our understanding of the molecular pathogenesis of cancers on an unprecedented scale. For example, we have now begun to unravel the dependence of certain tumors on some DNA repair mechanisms which makes them uniquely susceptible to DNA-damaging drugs. Several mutations or gene fusion abnormalities, when present in tumors make them susceptible to specific targeted drug treatments. Mutational profiling of DNA derived from tumors which are circulating in the blood (also called a liquid biopsy) has decreased dependence on tumor biopsies. Precise gene editing techniques like CRISPR have enabled scientists to insert or snip out specific DNA sequences which enable precise manipulation of specific pathways and networks in cell lines and animal models of cancer. Checkpoint inhibition-based immunotherapy has been one of the biggest successes in cancer treatment in recent years. The next generation of immune treatments involves even more sophisticated drugs like bispecific antibodies, drug-antibody conjugates and cellular immunotherapies like CAR-T cells, NK cells and others. These treatments promise to provide control or even cures for hitherto incurable cancers in advanced stages. However, the widespread impact on cancer care will require these very expensive tests and drugs to become more easily accessible to patients.

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