Precision medicine to boost cancer care

An estimated 2.5 million people in India suffer from cancer today, with over 7 lakh registering living with the disease every year. Though there are several advanced treatments and even drugs to treat this life-threatening illness, there is no guarantee that all patients will have a uniform response to them.

Particularly, this becomes more relevant when there is a second or third line of treatment where patients may have a 30-40% and sometimes just a 5% chance of responding. Still, treatment is provided knowing that 95% will not respond. This has been one of the biggest challenges for oncologists to practice.

The question, therefore, is why do certain people respond to a treatment, and others don't? The answer to the relentless fight against this deadly illness is in precision medicine, which is said to have a significant impact on patient outcomes for cancer. For one, it ensures that the patient doesn't endure any short-term or long-term side-effects.  

Generally, evidence-based medicine and radiation are given to patients who are suffering from the same type and are at the same stage of cancer. Their chances of responding to the treatment will differ. Evidence-based medicine means that in a clinical trial, certain percentage of people have responded to a treatment, giving the actual patients with similar symptoms a 50-60% chance of responding. Now, the other 40-50% who do not respond is deemed as an area of concern.

As we continue the quest to understand cancer better, two areas of interest - data analytics and analysis of DNA profile - have emerged for those patients who don't respond to regular treatment procedures. In such a scenario, identifying certain genomic variations which may be the reason why they remain unresponsive is vital.

For instance, we may see that a drug is not working for a disease, but if there is a certain genomic expression, it may yield results. Genetics can help us determine if a person is radio-resistant or resistant to certain drugs. But today, with sequencing of genes, we are beginning to understand the variation which may help indicate resistance to certain types of treatment. So, precision medicine will enhance the approach to treating cancer.

Setting up an Indian Genomic Bank could accelerate findings for advancing precision medicine and scrutinise appropriate cancer therapies. While analysing unique treatment outcomes, one needs to assess not just the genetics but also the age of a patient. It is important to know why a person has lived to the age of 80-90 years? What is the genomics of someone suffering from cancer and what is the difference in a person who doesn't?

Data from this kind of research will give us ample information to devise precision medicine for cancer patients and possibly even predict which type of people are likely to get cancer. Treatment that requires the technology of DNA editing could make a difference in preventing cancer, as well.  

Targeted therapies

India's case for precision medicine is certainly important because until now all our protocols are based on "occasion treatment". Medical fraternity in the country, and globally, is committed to precision medicine for delivering targeted therapies and companion diagnostics.

Development of partnerships between stakeholders such as academia, governments, industry and scientific organisations will allow access to the best science, most advanced technology, and the greatest expertise to successfully bring medicines to patients.

Only now can the science of precision medicine draw on a broad range of cutting-edge technologies such as genomics, next-generation sequencing, point-of-care devices, molecular image analysis, transcriptomics, proteomics, digital pathology, sensors, 'big data' statistical analytic techniques and artificial intelligence.

A person's lifestyle and the impact of environmental changes on his/her genetics, will bring genetic counselling to the forefront of chalking out precision treatment therapies to address health concerns of the patients.

The best way to help patients is to focus on breakthrough science to discover these mechanisms and develop novel, targeted therapies that interact with them. Redefining the cancer treatment paradigm could perhaps lead to the elimination of the disease being a cause of death one day.

(The writer is Chairman & CEO, HealthCare Global Enterprises & President, Association of Healthcare Providers India)

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