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Immuno-oncology - a new hope for cancer patients

Nilanjan Guha
Wednesday, December 28, 2022, 08:00 Hrs  [IST]

Immunotherapy, which works to harness and enhance the natural powers of the human body’s immune system, has proven to be an effective treatment against some type of cancers.

Cancer has rapidly emerged as a major public health challenge in India. An estimated 2.7 million cancer cases were reported in the country in 2020. The prognosis for the future is even more alarming: the number of Indians suffering from cancer disease is projected to reach 29.8 million in 2025.

Low levels of awareness, lack of screening programmes and diagnostic facilities, financial constraints, difficulties in reaching major tertiary cancer disease centres, and the stigma often associated with the disease, have led to a significant rise in the cancer disease burden. In addition to the tremendous physical pain and suffering that the patients may endure, the disease also puts enormous financial and emotional strain on patients, families, and health systems.

With the cancer case burden showing a steady increase, it has also accelerated the search for new therapies and protocols. Immunotherapy, which leverages and enhances the natural powers of a patient’s immune system, has proven to be one such effective treatment against some type of cancer diseases.

Traditional treatments for cancer disease
Until recently, surgery, chemotherapy, or radiation therapy, were the basic arsenal to remove, reduce, eliminate, or alleviate tumours. Chemotherapy is a systemic form of treatment and acts directly on cancerous tumours by attacking all rapidly dividing cells within the body. It can be used alone or in combination with other treatment modalities to send cancer into remission, make other treatments more effective and reduce the risk of recurrence, or relieve symptoms.

Unlike chemotherapy, radiation therapy uses high-energy radiation to destroy cancer cells or slow their growth by damaging their DNA. Radiation therapy can treat many different types of cancer and it can also be used in combination with other cancer treatments. It is estimated that more than half of people with cancer will receive some type of radiation therapy while their treatment. Radiation therapy is a localised treatment as it is targeted to the tumour, but inevitably some sensitive healthy tissues are in the path of the radiation (hair follicles on the skin, etc.) and are damaged by it.

Though effective, both chemotherapy and radiation therapy have limited scope to produce lasting benefits for patients with late stages of cancer. Moreover, they have often been associated with serious negative consequences. Because chemotherapy travels through the entire body, it can also damage healthy cells as they go through their normal cell cycle. These attacks on healthy cells often cause some of chemotherapy’s more well-known side effects, such as hair loss and nausea. Radiation therapy also has the potential to damage healthy cells situated close to the cancer growth which can cause side effects. Many people who undergo radiation therapy may feel exhausted during or just after treatment and experience fatigue.

Breakthrough treatment

Newer techniques such as immunotherapy have proven to be an effective treatment against cancer disease. Immunotherapy is designed to harness and enhance a patient’s immune system to fight the disease by enabling it to recognise, target, and eliminate cancer cells. Clinical studies have shown that beneficial responses to cancer immunotherapy treatment can be durable – about 20 per cent of patients achieve durable results with immunotherapy – and can be maintained even after treatment is completed. In addition, immunotherapy generally does not lead to the side effects commonly associated with chemotherapy and radiation.

A new and very promising form of immunotherapy is Adoptive Cell Therapy (ACT), in which the patient’s cancer-killing T-cells are genetically engineered to target them to the exact molecular phenotype of the patient’s cancer to make them highly potent and persistent in killing cancer cells (“Serial Killers”). Chimeric Antigen Receptor T-cells (CAR-T cells) are a breakthrough in cancer disease treatment, but to date have only been shown to be efficacious against hematologic cancers such as Acute Lymphocytic Leukaemia.  A large number of laboratories in both academic institutions and biopharma companies are working at breakneck speed to extend the efficacy of Adoptive Cell Therapy  to solid tumours.  

Adoptive Cell Therapy is quite costly due to the manufacturing complexity involved, which has pushed it beyond the reach of the average patient in India. To promote and support the development of Chimeric Antigen Receptor T-cells technology, the Biotechnology Industry Research Assistance Council, and the Department of Biotechnology, under the Ministry of Science and Technology, have launched initiatives to develop immunotherapy domestically. Researchers at the Indian Institute of Technology, Bombay, have developed a patented technology to develop Chimeric Antigen Receptor T-cells technology in India. The phase 2 and phase 3 clinical trial studies for this treatment are currently underway.

Improving the effectiveness and extending hope
Even as researchers working on immune cell-based therapies find it challenging to predict treatment efficiency and response, they are leveraging technologies like artificial intelligence (AI) in areas such as diagnostics, risk analysis, health information administration, lifestyle supervision, and virtual health assistance for better effectiveness. Artificial intelligence is being applied to predict immunotherapy responses based on medical imaging, immune signatures, and histological analysis. Along with artificial intelligence, the role of machine learning in drug development, from target selection and validation to more efficient clinical trials, is also being expanded.

There is an urgent need to engage all stakeholders in maximizing the impact of immunotherapy on current patients and those diagnosed in the near term. Building upon existing know-how available in research and diagnostics can further improve immunotherapy-based cancer treatment and thereby increasing treatable forms of cancer and delivering better healthcare solutions to all Indians.

(Author is Country Academia and Research Business Development Manager, Agilent Technologies, India)


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