Cancer is not one disease, but many diseases that occur in different areas of the body. Each type of cancer is characterized by the uncontrolled growth of cells. Under normal conditions, cell reproduction
is carefully controlled by the body. However, these controls can malfunction, resulting in abnormal cell growth and the development of a lump, mass, or tumor. Some cancers involving the blood and
blood-forming organs do not form tumors but circulate through other tissues where they grow.
A tumor may be benign (non-cancerous) or malignant (cancerous). Cells from cancerous tumors can spread throughout the body. This process, called metastasis, occurs when cancer cells break away from the original tumor and travel in the circulatory or lymphatic systems until they are lodged in a small capillary network in another area of the body. Common locations of metastasis are the bones, lungs, liver, and central nervous system.
Dr. Ravi Jaiswal, Head of Department, Medical Oncology Ramkrishna care Hospital says immunotherapy is the most promising area in oncology at present. While it offers hope, the therapy is expensive and merely 5-10% people in India can afford it. Times of India chats with Dr. Jaiswal about this latest buzz word:
- What is Immunotherapy ?
- Cancer cells are produced in the body all the time but most of these cells are taken care of by the body’s immunity. When the body’s immunity is good, these cells are killed by the immune cells. If the body’s immunity fails or the cancer cells develop a protective mechanism due to which their antigens are not exposed to the immune cells, they don’t get killed. Immunotherapy involves strengthening the body’s immunity by various mechanisms — either by giving antibodies like rituximab or trastuzumab; by giving checkpoint inhibitors; or taking out the cells from the body and re-engineering them in such a way that they can fight cancer.
- For whom ?
So far, we have been treating cancer with surgery, chemotherapy, and radiation therapy
but they have limitations. For example, surgery may not be possible in large, inoperable tumours. At times, the tumours are operable but the cancer has spread to other parts of the body and thus the local treatment doesn’t work. The same holds true for radiation therapy. Chemotherapy kills cells across the body but again there are chances that the cells develop resistance. Initially we started offering immunotherapy
only in advanced and relapsed cancers, but now many patients are getting this therapy upfront.
Yes. Immune therapy
is expensive because all the drugs are imported and patented in the West. Currently, the therapy can go on for years and cost can go up to ₹15-40 lakh. The CAR-T cell therapy, a form of immune therapy that involves re-engineering the body cells, costs up to $650,000 for a single dose. But it is not being offered in India. Some of our patients have gone to the U.S. and China to take it. Immune therapy
works in nearly 20% of patients and in oncology, 20% is a considerable number.
But in a set-up like Tata which gets mostly non-affording patients, is it possible to offer this therapy?
A small number of patients afford it somehow. The recommended dosage of the drugs is very high but at Tata, we are trying to work around by reducing the dosage and increasing the interval to make it cost-effective. We are experimenting, thinking out of the box, to offer it to our patients.
Is there a solution?
Creating our own generics will eventually help. In the U.S., all the generics are tested before they come into the market but here we don’t have any mechanism to ensure that. Many of our generics fail and thus the government has to ensure that the quality of generics is good. Another way we are trying to find cost-effective immunotherapies
is by developing ‘metronomic therapies
’. As against ‘check point inhibitor’ therapies that stimulate body’s immunity, ‘metronomic therapies’ work by eliminating the inhibitory immunity or the bad immunity. These are very low cost treatments and along with other treatments may really become effective in eliminating advanced cancers.