"The Charisma of Personalized Cancer Treatment" | Dr. Kshitij Joshi | Consultant Cancer Specialist | Mumbai Oncocare Centre- Vile Parle

The term, 'Personalized Cancer Treatment' is gaining an extraordinary importance and popularity among oncologists globally and in India to a large extent. It intends to offer optimum treatment to cancer patients based on the specific genetic abnormalities, the biological and the molecular characteristics of their cancer. This novel phenomenon is expected to transform the outlook of cancer treatment in future for the benefits of cancer patients.

With the limited understanding of the cancer biology in the past, it was believed that all the cancers deriving from the same site / organ were biologically similar and the disease was classified on the basis of assessment of the cancerous cell-type under the microscope, the presence and size of a nearby (regional) lymph node affected by cancer, the distant spread of the cancer to other organs in the body and few other features observed on the tumor sample. E.g., Cancer of a lung if limited to lungs only can be classified as stage 1 or 2 disease. If it is spread to organs beyond the lungs, like nearby lymph nodes and to a distant organ like brain, it can be termed as stage 3 & 4 (metastatic disease) lung cancer.

Cancer specialists also follow a grading system of cancer cells based on how identical they are to the normal cell of the given cancerous organ. Cancer cells have a tendency to lose their distinct identity from the normal cells thereby losing their ability to perform a designated function, e.g., function of respiration by lung cells. Lung cells for example have a distinct structure (different from that of stomach cells) for a specific function of respiration. When lung cancer occurs, some or many of the lung cells lose their identity to become poorly differentiated, thereby altering the normal functioning of lung cells. The exercise of finding the structural identity of the cancerous cells is termed as grading.

For many years until the last decade, oncologists had been treating cancer patients with the treatment modalities like Radiotherapy and Chemotherapy in addition to cancer surgery, based on the stage and the grade in which disease of the patient falls. Chemotherapy potentially kills all the fast-growing cells (like cells of human hair, nails etc.) along with the cancer cells in the patient's body. It is a pervasive fact that being non-specific in its action, chemotherapy produces a lot of side effects to patients, and it is the biggest drawback of it.

Reiterating the fact that 'God Lives in Details, the cancer researchers began digging deep into the cancer biology to evolve to the improved understanding of defects in the genes and other abnormalities at the molecular levels that generate cancerous cells. Citing an example of breast cancer, oncologists have made it a protocol to identify defects at the molecular level by ordering immunohistochemistry (a diagnostic test) to find out mutation of HER2 receptors. To simplify for our readers, HER2 is a receptor on the cell surface that gets amplified by the mutation (genetic defect) in case of cancer. Such an amplification is a proven phenomenon that triggers formation and rapid growth of cancer cells in breast and stomach cancer. From an opportunist's perspective, it is a target that can be blocked / treated with a monoclonal antibody (a different kind of a cancer treatment) to quell receptor's overwhelming function and gain control over cancer genesis and the spread in the human body.

The invention of such a differential therapy (antibody) that can specifically target the defect at the molecular level of a cancerous cell are termed as personalized cancer treatments and it turns out to be a blessing for a cancer patient. It will be specific in its function of repairing the defect without impacting normal cells in the body. Such an organized treatment mechanism leads to minimal side effects in cancer patients thereby improving their quality of life while the cancer is treated. There are many such innovative targeted treatments available in the armamentarium of the oncologist for the treatment of cancer patients and there are many more under development. The latest invention of Immunotherapy for cancer patients is another disruptive innovation that acts by correcting the major and minor defects in the human immune system which were allowing cancer cells to escape the body's natural defense. Immunotherapy works by re-activating human immune system against cancer to contain the growth of it to a large extent.

During my practice over the years, I have realized that the personalized cancer treatments are an outstanding resource not only for the cancer patients but for the cancer treating specialists. These treatments help in improving our conviction that even the difficult and advanced of the cancer cases can be treated with ease and for the best patient outcomes.

I must mention here that some of these personalized cancer treatments are 'overwhelmingly promising' at their best and 'catastrophically expensive' at their worst as we stand today. After the Drug Controller General of India (DCGI) intervened to enforce a Drug Price Control Order in the form of 'The National List of Essential Medicines' and included a few personalized and other cancer medicines in it, some of these personalized medicines have become highly affordable. Government of India with the help of many pharmaceutical companies are trying their best to make these treatments available at the cost that can be afforded by majority of the cancer patients from various economic strata. I am sure it is only a matter of time that these therapies become available for the treatment of masses and does not remain the choice of the classes. 

Dr. Kshitij Joshi, MD. DM. ECMO.
Consultant Medical Oncologist
Mumbai Oncocare Centre
8879026609 | 022-26200868
drkshitijjoshi@mocindia.co.in
www.mocindia.co.in

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