Better understanding of tumour biology effective for cancer treatment

Dr Muzammil ShaikhWednesday, February 27, 2019, 08:00 Hrs  [IST]

Cancer -  any malignant growth or tumour caused by abnormal and uncontrolled cell division and it may spread to other parts of the body through the lymphatic system  -  Is it the end of life? I would say, make no mistake, we can fight things out as long as the diagnosis and treatment go in the right time in right direction. Better understanding of tumour biology obviously will help to provide effective cancer treatment.

Cancer, in very plain and simple terms, can be explained as rampant cell growth, of abnormal cells’ proliferation anywhere in the body. Not many know that there are around 100 types of cancers and any organ or part of the body, for that matter, can be affected by cancer. Often, it is being noticed that cancer cells break away from the original cluster of cells, travel across the human body, and find a new home in other organs where they continue to trigger rampant cellular growth, what alternatively we call metastasis.

The leading cause of death in the world, cancer affects nearly 9.5 million globally, as per the World Health Organization’s data released in September 2018. In India, the scenario is not too different either as nearly 2.25 million people are estimated to be affected by cancer in 2018 and nearly 11.5 lakh new cases are registered every year, data of the National Institute of Cancer Prevention and Research (NICPR) shows. Moreover, our country has witnessed 7.8 lakh deaths due to cancer in 2018. In fact, the average age for breast cancer in India is almost a decade lower than that in the West.

With rising incidences of cancer, it is incumbent on the medical fraternity to come up with efficient and targeted treatments aimed at arresting the mortality rate.  

It is important to understand for people that cancer is not the end of life. There have been several advances in terms of treatment which augments survival rate and at the same time ensuring quality care for the cancer patients. Thanks to newer studies that are taking place in the field of cancer research; there have been interesting developments and all too advanced treatment options that patients can avail of.

In fact, a lot is being done in terms of newer treatment options globally and in India in particular. If we look at the history, it was just chemotherapy which was considered the first and the sole option when it comes to tackling cancer. With better understanding of tumour biology, we are now able to able to target specific areas of cancer cells providing better treatment results and less side-effects.

While the earlier traditional cancer therapy destroyed all the cells randomly, targeted therapy focused on destroying only cancer causing cells.  

A little later newer vistas opened up in the form of Immunotherapy, which is still a lesser known treatment. “Immuno” in Immuno-Oncology (I-O) refers to your immune system. It uses special drugs known as immunotherapies that target the human body’s immune system to help fight cancer.

However, this remains a relatively new therapy area but has seen steady success in patients. The use of immunotherapy for cancer treatment is an innovative therapeutic tool that adds up to traditional weapons currently used against cancer- like as surgery, radiation therapy and biological therapies. Most of these  treatments are directed against the cancer-causing cells.  

Also, immunotherapy has been a game-changer and a major milestone in clinical intervention especially when looked at improving average life-span of patients and improving their quality of lives. According to the US Food and Drug Administration, these drugs helped alter the life-spans of the cancer patients.

And, contrary to chemotherapy and targeted therapy, immuno-oncology strengthens the body's internal defense mechanism and can thus offer a different treatment option in the fight against various types of cancer. It’s a step ahead, a marked departure from the traditional methods of cancer treatments that are approved worldwide. Generally, immunotherapy is used, when other treatment options fail to work on the patient, except certain cancers wherein it can be used as a frontline treatment. Eg: carcinoma lung and Melanoma. Presently, this therapy is commonly used to treat head and neck tumour, lung cancer, urinary bladder tumour, kidney cancer, melanoma, lymphoma and a subtype of breast cancer.

Since lot of research is taking place on these drugs for the treatment of other types of cancer as well, we are witnessing announcements and newer developments in terms of newer direction of clinical interventions. These developments are welcome since they open the doors for the medical fraternity to consider and embrace Immunotherapy as a viable treatment option.

However, in the coming years, we would see many more upcoming indications wherein Immunotherapy can be used as a treatment method. There are various studies which are ongoing, which will throw up solutions for other types of cancers too.

Also, since the therapy directly targets through immune system, they occasionally produce immune related side-effects like immune colitis, pneumonitis, immune- thyroiditis etc.

However, there are no common outcomes of treatment. It is imperative that selection of patients for immunotherapy treatment be done appropriately, as not every patient responds to this therapy.  Therefore, there are certain tests carried out on the patient to check and determine if the patient has more chances of responding to immunotherapy.

National Institute of Cancer Prevention and Research data suggests that Indian men stand at 9.81 per cent risk of developing cancer before the age of 75, while the same for women is 9.42 per cent. This is an indication even the younger population – let’s say people in their 30s - 50s are also at risk of developing cancer. Considering these statistics, newer studies and research is on for better efficiency rates, better survival rates, lesser side-effects and overall better results.

One such study is on CAR T cell – which is also known as T cell therapy. This is a type of immunotherapy in which the cells of the patient are sent to the lab to be added to receptors or certain proteins. These cells when sent back to patient’s body identify and fight the cancer cells. However, it is too early to apply this therapy across all types of cancer. Researchers are studying how to apply this therapy for various types of cancer, which is presently used only for certain blood cancer type cases.

Apart from T cell, various other studies are being conducted to understand the efficiency of combination therapies. Firstly, using Radiation and Immunotherapy together and secondly Chemotherapy and Immunotherapy together as a treatment are being carried out how the cancer cells respond. These are called combination therapies and such treatment methods are the future face of cancer treatment in India.

To sum up, extensive studies are being carried out to improvise chemotherapy. The studies, would determine bringing out better and improved results and also lesser side-effects. The future looks bright and better with newer therapies and drugs for treatment.

( Author is a medical oncologist, Hinduja Healthcare Surgical)