‘There Is A Need To Develop New Molecules For Targeted Therapy’

Dr Suresh H Advani

Targeted therapy is the buzzword in the treatment of cancers, whether it is chronic myeloid leukemia (CML), breast cancer, colon cancer or lung cancer. And Dr Suresh H Advani, Director, Department of Medical Oncology, Jaslok Hospital and Research Centre is a proponent of that. Dr Advani started his glorious career as Assistant Medical Oncologist with Tata Memorial Hospital (TMH) in 1974. He went on to hold the reins of Medical Oncology department as Professor and Chief, Department of Medical Oncology, Jaslok Hospital. A pioneer in establishing bone marrow transplantation in India, he has also played an important role in establishing D M Medical Oncology (Mumbai University) at TMH. For his contribution in the field of cancer treatment, he has been conferred with Padmashri, in 2002 and highest medical award Dhanvantri. In an interview with Shardul Nautiyal, Dr Advani elaborates on how targeted therapy can prove to an effective treatment modality and what needs to be done to improve cancer treatment in India.

What are the latest trends in cancer?

Cancer is the second most prevalent disease after cardiac related problems. What is of serious concern is the predominantly growing prevalence of mouth cancer, lung cancer, cancer of the esophagus in males across the country because of tobacco use. As success rate is less than 10 per cent in lung cancer, prevention is the key. Interestingly, lung cancer has shown a declining trend in the US in the past few years because of the awareness created in the public. In India, shockingly, lung cancers have become more prevalent, which is a matter of serious contemplation and needs attention from the medical fraternity and the government.

Another area of concern is that breast cancer in females is also on the rise because of sedentary lifestyle brought in by urbanisation. Late marriages, getting first child late leading to small lactation periods, lack of exercise and consumption of high fatty food have predisposed the females, in urban areas to breast cancer. Bombay Cancer Registry, which collects all cancer-related information in Greater Mumbai, reveals that one out of 30 females in India suffer from breast cancer as against one out of eight females in the US. The prevalence of breast cancer in rural areas is less as compared to urban areas because of early marriages and long lactation periods. Besides, rural women are less predisposed to breast cancer as they do a lot of physical work and have less fatty diet. But the figures are no less alarming. According to a study in Barshi, a rural pocket in Maharashtra, one out of 100 women suffer from breast cancer.

What are the recent advancements in cancer treatment? How equipped is India to treat cancer?

More cancer treatment centres are required as three lakh new cancer patients are added on to the existing list of cancer patients every year. Targeted therapeutics is the most upcoming treatment modality, which targets the tumour cells and not the normal cells. Drug nowadays in use for targeted therapy is Glivec, which is considered the most effective for eliminating CML tumour cells. Targeted therapy is equally an effective therapy for breast cancer, colon cancer, lung cancer also.

Another effective treatment approach in cancer is combined modality treatment, which is orchestrated by a team of surgical oncologists, medical oncologists and radiation oncologists, with the objective of eradicating the cancer completely.

Besides this, by combining different modalities, we are now able to do organ preservation surgeries. Through this surgery, we can remove the tumour first and then do the treatment by chemotherapy and radiotherapy. This approach is very new in India, but is familiar with major regional cancer centres like Jaslok Hospital, Mumbai, S L Raheja Hospital, Mumbai and TMH, Mumbai. Intensive Modulated Radiation Therapy is another upcoming area of cancer treatment, which targets the tumour tissue. The silver lining in the cloud is that drugs and surgery have become cheaper over a period of time. The cost of bone marrow transplantation in India is far more reasonable than in the US. It costs around one crore in the US, while it is only Rs five lakh in India.

The government of India should introduce and develop cancer treatment divisions in every medical teaching college across the country. This will help students to get hands-on training and the patients will be able to avail the treatment in medical colleges as well.

Please tell me about the research in targeted therapy, considered the most upcoming area of therapy with regards to the human genome project.

There is a need for clinical research facilities, which would ensure development of new molecules for targeted therapy. With the development of Human Genome Project in the past few years, we have been able to understand the mechanism of development of cancer and therefore the significance of targeted therapy. We have also been able to understand as how to diagnose and and how to treat cancer through Evidence Based Medicine (EBM).

What are the financial, infrastructural and organisational issues related to cancer diagnosis and treatment in India?

Cancer treatment is a sophisticated and time-consuming treatment with chemotherapy taking as along as six months. It is also capital-intensive with a set-up for a good blood bank costing around Rs three to Rs five crore. The set up also requires radiotherapy equipment costing around Rs 10 to Rs 20 crore and radio-diagnostic machines costing another Rs five to Rs 10 crore. Installing a linear accelerator would cost another eight to Rs 10 crore.

What are the various programmes conducted by the government or any private agency to make cancer treatment affordable and accessible to the common man?

Cancer patients look out for psychological and financial support as cancer treatment is very expensive. Indian Cancer Society is doing a commendable job in helping the patients financially, enabling them to buy drugs at a cheaper rate.

Which are the active cancer treatments centres in the country? How many more centres are required?

We have 30 major cancer treatment centres in the country, the major ones being All India Institute of Medical Sciences (AIIMS), New Delhi, TMH, Mumbai, Jaslok Hospital and Research Centre, Mumbai, Apollo Hospitals, Chennai, Adiyar Cancer Institute, Chennai and Amrita Institute of Medical Sciences (AIMS), Cochin. We would require 50-100 centres in the country in total.

Are cancer treatment facilities available in rural areas?

Most major cancer centres are located in urban areas. Even major voluntary organisations, NGO-funded hospitals are located in urban areas. Rural masses, therefore, do not have any access to centres situated in the urban areas.

Please brief me about the latest researches in cancer.

Clinical research activities are going on in Jaslok Hospital and Research Centre, Mumbai and S L Raheja Hospital, Mumbai. MNCs are coming forward to help us in this direction. There are currently 10 companies in the country, who are manufacturing Glivec, indigenously. This has brought down the cost and ensured affordability of drugs.

The success rate in cancer treatment is gradually improving. Jaslok Hospital performs four transplants per month. Most of the cases done at Jaslok Hospital are of CML, acute myeloid leukaemia (AML), aplastic anaemia and thallasaemia. Thirty years of experience in the field of cancer research and cancer management as well as new opportunities both at Jaslok Hospital as well as at S L Raheja Hospital have allowed me to develop modern clinical research and cancer treatment facilities in order to provide suitable new technology treatment to our patient.

We are also involved with public education regarding cancer treatment and cancer research. We have also started an NGO for financial and psychological support for our patients. We will also launch a mobile mammography van for screening breast cancer.

What are the guidelines for standardising cancer diagnosis and treatment?

International guidelines are in place for different kinds of cancers and their respective stages. There are around 200 cancers with their different stages. At a nation-wide conference organised by the Indian Society of Oncology in Jaipur last year, guidelines for breast cancer, cervix cancer, lung cancer and eosophagus were framed, under the chairmanship of Dr P B Desai and myself. Nevertheless, international guidelines based on EBM should ideally be followed.

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