The Future of Cancer care will include less and less chemotherapy. Immunotherapy and targeted therapy and combinations of these treatments will increasingly be used. Stage 4 cancer will become a chronic disease and patients will live with cancer instead of dying from it.

So is this a fantasy? Not really. It is likely in the next 10 years. We inch closer every year.

Let’s talk about Immunotherapy first. This is a treatment which enables our body’s own killer cells called T cells to recognize and kill cancer cells. It basically boosts our immune system against cancer. 

The ASCO annual meeting is the largest Oncology meeting in the world and takes place every year in June with over 35000 attendees. The best of cancer treatment research is presented here. A lot of data on Immunotherapy was presented this year. 

Immunotherapy was first used in tumours like Melanoma (skin cancer) and Lung cancer. It was recommended for stage 4 cancer where the disease had spread throughout the body. Immunotherapy works for some and not all of these patients. In the 20 or 30% that respond, the effect is dramatic. Tumours shrink and disappear and response lasts for a long time, sometimes for over 5 years!

This year at the ASCO conference, new data emerged for the benefit of Immunotherapy in stage 4 esophageal or food pipe cancer. Patients who received Immunotherapy with chemotherapy were likely to live several months longer than those who got chemotherapy alone. At 2 years, 78% of patients were alive with Immunotherapy compared to 63% who didn’t get it.

More interesting data was presented for Immunotherapy in the early stage. That is, using it before or after surgery and radiotherapy to prevent cancer from relapsing. This is exciting because now Immunotherapy for the first time is showing good results in early disease and increasing cure rates of patients with different cancers.

Data presented at this meeting is promising for patients with high risk Kidney cancer. One year of Immunotherapy with a drug called Pembrolizumab prevented the cancer from coming back in almost 80% of patients at 2 years.

Similar results were seen for patients with esophageal or food pipe cancer after surgery. Immunotherapy with the drug Nivolumab benefitted patients who were treated with it, much more than those who did not receive the drug.

In Lung cancer also, Nivolumab with chemotherapy when given to shrink tumours made surgeries easier and patients receiving this combination had better recovery.

Urinary bladder tumours also respond to Immunotherapy well. Those with stage 4 disease survive longer. Now there is data to show that in combination with chemotherapy, Immunotherapy can spare some elderly patients the morbid surgery of bladder removal. 70% of patients who did not have a surgery after this treatment remained well.

Next let’s switch to Targeted therapy. Targeted therapy is basically an oral or IV drug which targets a particular mutation that drives the growth of a particular cancer. Unlike chemotherapy it spares normal tissues and has fewer side effects. Targeted therapies have been in use for over 25 years and have been particularly useful in Lung cancer, Breast cancer, Kidney cancer and Ovarian cancer.

This year at ASCO there was encouraging data for Breast cancer. 5 to 10% of all Breast cancer patients have a hereditary type of cancer due to mutations in the BRCA gene. These patients develop a very aggressive type of tumour. The study presented at this meeting showed that the drug Olaparib, targeted against tumours with BRCA mutations, when given to patients after surgery and chemotherapy reduced the chances of relapse substantially. Over 80% of these patients in the study had triple negative breast cancer which is particularly difficult to cure. So this is indeed good news.

A group of drugs called CDK 4/6 inhibitors which have been in use for advanced breast cancer are now being used after chemotherapy and surgery to prevent the cancer from coming back. Abemaciclib, one of these inhibitors, was shown to be particulary useful if given with hormonal therapy for 2 years in women with large, node positive tumours in preventing relapses.

The usefulness of these CDK 4/6 inhibitors in stage 4 breast cancer remains. All 3 drugs Palbociclib, Ribociclib and Abemaciclib have shown to prolong life by over one year in these patients when used with hormonal therapy. They must be offered to our patients and Pharma companies are offering these drugs at affordable prices in our country.

Targeted Radiotherapy which uses radioactive isotope treatment can prolong the survival of patients with stage 4 prostate cancer. This is a big breakthrough and what's better news is that it is available in India.

Newer targeted therapies were also found to be useful for rare cancers like sarcomas and childhood brain tumours.

There is a flip side though. Most of these Immunotherapy drugs and targeted therapies are available in India. Yet some are not accessible to our patients due to their exorbitant cost. Often Insurance companies are not willing to re-imburse these treatments. There should be a way to make all these treatments available to our patients. Right now only a privileged few are receiving it and benefitting from it. It is estimated that more than 90% of our population is currently denied more effective and less toxic treatment for cancer. So while the West will enter into a new era of Cancer treatment, countries like ours will sadly lag behind.

Is it possible to detect cancer early by a blood test? This may be the case in a few years. Exciting data was presented as ASCO this year which showed that it is possible to pick up small fragments of tumour DNA 

in the blood and diagnose Lung cancer and Colon cancer early, even before symptoms begin. Other companies are extending this diagnosis to include breast and stomach cancers as well. Although this technology is not ready for immediate use, it is extremely encouraging.

To conclude, cancer care is changing at a rapid pace. It holds promise with chemotherapy free treatments and newer Immunotherapy and targeted therapy combinations. Importantly, more patients in India should get access to these revolutionary treatments and every effort must be made to ensure this. The ultimate dream could be a cancer free world.

Dr. Shona Nag is widely recognized as one of the best oncologists in Pune, earning her reputation through years of dedicated service and expertise in cancer treatment. She is acclaimed for her specialization in breast cancer, making her one of the best breast cancer specialists in Pune. Dr. Nag's compassionate approach, combined with her extensive knowledge, ensures her patients receive the best possible care. Her commitment to staying updated with the latest advancements in oncology has solidified her position as the best cancer specialist in Pune. Dr. Shona Nag's comprehensive and patient-centric treatment plans make her a highly sought-after oncologist in the region.