Dawn of a New Era in Cancer Therapy

Dawn of a New Era in Cancer Therapy

Dawn of a New Era in Cancer Therapy

Treatment of cancer has evolved dramatically over decades. What used to be a domain of a surgical oncologist primarily has evolved to a multidisciplinary treatment approach that has equal or rather more weightage to other forms of treatment like radiation and medical management of cancer. Role of medical management has become prominent in the process, initially with chemotherapy and now with modern medicines like targeted therapy and immunotherapy being available in the armamentarium of onco-physicians.

In this article, I will be surfacing some of the ground rules and fallacies that are important for improving patient outcomes in oncology. Treatment of any cancer begins with a hypothesis that it is a systemic disease to begin with and it has been proven by the inclusion of chemotherapy in what is classically called as the adjuvant treatment of stage 2 and stage 3 cancers post-surgery. It has been proven with evidence that adjuvant chemotherapy, those to be given post the primary surgery / radiation; have improved patient survival as compared to leaving patients to a chance to survive. The role of chemotherapy in a metastatic disease was always defined, proven and undisputed.

Now a days we are moving ahead of chemotherapies which were considered to be the part and parcel of oncologic treatment. Modern medicines like targeted therapy and immunotherapy with the available evidences have further deepened the belief that medical management of cancer is all pervasive. Beyond a tumor size of 2 cm, role of chemotherapy or other forms of medical management becomes obvious in the interest of survival. Critics would play devils advocate that medicines like chemotherapy compromise the quality of life of those patients however modern medicines have changed the outlook of cancer treatment for better.

Bespoke would be an apt adjective to modern cancer medicines. Unlike chemotherapy, they target cancer cells specifically, offering improved efficacy with much lesser side effects. Trastuzumab is one such example that works on HER2 neu receptors which is an identified target in breast cancers that amplifies cancer growth upon mutation or overexpression. Trastuzumab has dramatically improved survival and quality of life in HER2 positive breast cancers.

In many solid cancers, it is a prerequisite to diagnose identified mutations before starting of any treatment. If those mutations are positive, then patients can get away with chemotherapy and take targeted therapy or sometimes, a combination of both for better results. EGFR positivity in lung cancer is one such example that makes way for EGFR targeted therapy and minimizes or nullifies the role of chemotherapy in such patients.

Immunotherapy is the next level of satisfaction as it imposes our immune system to work against cancer cells for long term outcomes as well as quality of life of highest order. There are 4 to 5 immunotherapies available in India which have improved outcomes in lung, bladder and many other forms of cancer.

Last but not the least, treatment outcomes and side effects of therapy depend on where patient is taking chemotherapy or any modern modality of treatment such as targeted or immunotherapy. Taking such treatments under guidance of a medical oncologist is always and has to be on priority list of patient and patient’s relatives as it will going to minimize patients’ burden financially and also in terms of minimal side effects of therapy.

To summarize, medical management has a dominant role to play in cancer treatment, irrespective of the stage of cancer. The newer molecule in the management of cancer is going to be dawn of a new era in cancer therapy!!

Dr. Akshay Shivchhand

Consultant Medical Oncologist
Mumbai Oncocare Center, Kolhapur.