The future of cancer care

Cancer is a global health challenge that accounts for one-sixth of all annual deaths globally. It’s a difficult-to-understand illness with potentially fatal implications.

Oncology treatments are ever evolving, challenging the concept of onesizefitsall and generalization. Progress in cancer care has brought hope to cancer patients over the last two decades, courtesy to scientists’ and oncologists’ capacity to better comprehend cancer biology and devise treatment plans based on that knowledge. Each person is unique and so is their cancer.

At a basic level, cancer is a disease caused by uncontrolled cell proliferation caused by abnormalities in the genomic make-up and mechanism. Cancer may arise as a consequence of innate genomic abnormalities such as mutations, deletions, gene amplifications or rearrangements, the body’s immune system, or external assaults such as tobacco, alcohol, chemicals, infections, and radiation. Precision medicine is a concept that entails designing a personalized cancer treatment strategy based on a thorough understanding of the mechanisms that cause a given disease. Novel treatment approaches are being explored to enhance survival and minimize side effects associated with treatment in order to preserve quality of life.

Although standard of care guidelines are specific to the cancer type and may involve different modalities of cancer treatment like surgery, radiation, chemotherapy, targeted therapy and immunotherapy the unique biology of each tumor has become integral to cancer care worldwide.

A comprehensive plan of care with experts discussing the nuances of each case is very much a reality and no longer futuristic. This usually happens in tandem with the identification of a diagnostic route, in which we unravel the mystery specific to that patient’s cancer. Beyond the obligatory typical histopathologic investigation, this is accomplished by conducting Comprehensive Genomic Analysis and even further by performing Multi-Analyte Testing to study the DNA, RNA, proteins, the metabolic functions within the cancer cells and the tumor microenvironment.

Understanding cancer biology and developing treatment options based on that knowledge has resulted in a paradigm shift in cancer management and disease outcome.

Biomarker discovery and designing therapeutic strategies based on that are largely concepts being applied to late-stage cancers. However, the field is progressing, and with that the application of precision medicine is moving into cancer prevention and to the early stages where the goal is to prevent disease relapse.

Targeted therapy and immunotherapy are two examples of novel therapeutic applications that are being utilized to enhance outcomes, improve survival and make cancer treatments less morbid. Such medications are now being used to prevent cancer from returning, in addition to improving outcomes in advanced cancers.

Although, most of these medications are now available in India at reasonable cost, immunotherapy remains prohibitively expensive, restricting its use. Bringing clinical trials with these novel drugs into the country is one way to boost access.

The arena of immunotherapy, which includes cancer vaccines, adaptive T cell therapy, and CAR-T cell therapy, is another key area of advancement in customizing oncologic therapies. These techniques are mostly used in blood cancers, however, these strategies are emerging in solid tumors too.

Genomic analysis and biomarker identification are so integral to cancer care that they are going to become a mandatory part of diagnostic investigation and critical to appropriate therapeutic application. The objective and endeavor is to lower the cost of such testing and make them routine, so that informed decision-making becomes the rule rather than the exception!

END OF ARTICLE