Precision Oncology and personalized medicine

4th February 2023 – World Cancer Day

Dr Srinath Bharadwaj

World Cancer Day is being observed on February 4th every year from the Year 2000. Started by Union for International Cancer Control (UICC) to campaign and spread awareness about cancer by adopting, different themes every year, in 2022 UICC called for a 3 year campaign for impact and chose a common theme for years 2022-2024 : Close the care gap. The first year 2022 was about recognizing the inequities in cancer care around the globe, question the status quo, help reduce stigma, listen to perception of people living with cancer so that their experience guide our thoughts and actions, in such a way that we begin to imagine a better way of doing things and build a fairer vision of the future. The 2nd year for this campaign is about uniting our voices with like minded people and taking action step by step towards achieving our dream of a cancer free World. On this world cancer day I would like to bring to your notice the 5 major scientific milestones which have made a huge impact in care for cancer in the past decade.

I. Immunotherapy: This is definitely one of the path breaking discoveries in the past decade. Tumors grow in our body by evading / misleading our immune system. This therapy brings back the cancer under the radar of our immune System and increases the effectiveness of other therapies in turn providing longer periods of remission. Significant impact has been seen in many cancers especially Lung cancer.

II. Next Generation Sequencing: Massive Parallel Sequencing of tumor DNA / RNA to detect specific mutations in the genome which could have been the cause of his / her cancer. Once a mutation is detected, we also get to know if this is hereditary and if is there is any drug which can target this mutation. This makes Cancer treatments more personalized. BRCA gene testing in breast and ovarian cancers, EGFR, ALK, Ros testing in lung cancers, MSI testing in colonic and many other cancers are examples.

III. Targeted Therapies: These medicines are a direct consequence of our ability to delineate targets in individual tumors through various molecular teste including Next Generation Sequencing. Most of the targeted therapies come in tablet form which makes administration very easy for the patients and avoids multiple chemotherapy injections.

IV. PROTON Therapy: The therapies previously discussed are either tablets or injections. This therapy is a form of Radiation therapy. Conventional Radiation therapy Consists of Photons generated at Mega voltage to treat cancers. In proton therapy particles called Protons are used instead of photons to improve precision and decrease side effects and Apollo is the first hospital to introduce it in India. This is most useful in treating tumors which are nearby critical organs like brain and spinal cord.

V. Developments in supportive care: Array of new Medicines have come up in the last decade which are much more effective in tackling nausea and vomiting associated with chemotherapies. Scalp cooling machines are available which prevent hair loss for patients on chemotherapy. Various interventions from Radiology and Pain Medicine have made treatments more tolerable and the journey of fight against cancer more comfortable than ever before.

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