Cancer treatment technologies need high-scale adoption by India's Hospital Care ecosystem

by Dr. Rajesh Bollam

Cancer is one of the leading causes of global deaths due to critical illness. According to the World Cancer Research Fund, there were an estimated 18 million cancer cases around the world in 2018. The stats are even more alarming for low and middle-income countries, as they contribute to more than 70 percent of global cancer deaths, as per the WHO (Source: https://www.who.int/news-room/fact-sheets/detail/cancer ). India is also amongst the high attributers of global cancer cases. Being stagnant for over a decade, the country’s cancer care infrastructure needs a high-scale adoption and efficient implementation of the latest cancer technologies.

Chemotherapy and radiotherapy are still the most commonly used cancer treatments in the country, however, most treatment cases lack a focused strategy, leaving patients exposed to antibiotic resistance. In recent years, many innovative concepts have emerged to improve the cancer treatment outcomes that are rather poor with traditional therapy options. The next generation of cancer treatments is being driven by new therapeutic tactics including areas like energy metabolism and extracellular vesicles, as well as breakthroughs in immunotherapy and nanotechnology. With the global cancer burden on the rise, cancer prevention is a very significant public health challenge and certain emerging technological innovations are taking them head-on.

• Immunotherapy

It has had a dramatic impact on cancer management. The immune system—with assistance from therapy and medication—destroys cancer cells or slows down the growth of cancer. This technique is instrumented for cancer treatment through various methods, with Checkpoint Inhibitors, Chimeric Antigen Receptor (CAR) T-cell Therapy, Cytokines, and Immunomodulators being the most advanced methods of immunotherapy, while more methods are being studied.

• CRISPR/Cas9

CRISPR/Cas9 has revolutionized the field of gene editing by simplifying the process of modifying DNA sequences with high precision. CRISPR could be used for the enhancement of CAR-T therapies over the current generation of CAR-T products. Recently, China moved forward with human clinical trials using a combination of CRISPR/Cas9 and CAR-T therapy to treat different forms of cancer. While the early results were promising, studies are still ongoing. In India, CAR-T Cell Therapy’s first trial took place in June 2021, at Tata Memorial Hospital, Mumbai. The trial saw successful results, dramatically improving the chances of CAR-T Therapies’ mass-adoption in the country.

• Personalized Cancer Vaccines

Vaccines have been successful in preventing and eradicating several diseases over the years. However, adopting a similar approach for cancer could be tricky as cancer mutations are different in patients suffering from the same form of cancer. Currently, personalized cancer vaccines are being explored by several Biotech companies across the globe. Germany-based BioNTech in collaboration with India’s Genentech is developing personalized mRNA vaccines for cancer treatment. These mRNA cancer vaccines—carrying messenger responses to trigger a strong immune response—have shown positive results in the first human trial. CureVac and Moderna are also working on a similar cancer vaccine. With the success of the mRNA COVID-19 vaccines, this technology holds a lot of potential.

• Robotic Surgeries

Certain cancers require patients to undergo surgery for the removal of tumours and infected tissues (organs, bones, etc). Robotic surgeries have increased the success rates of such complex surgeries; the technology has been assisting surgeons in reducing operation time and lessening the chances of side effects associated with traditional surgical practices. Robotic devices used in surgery have greater dexterity and range of motion as compared to surgeons with laparoscopes. The success of robotic surgeries varies depending on the predisposed condition of the patient, cancer type, the surgeon's experience, and preference and part of the body being operated on. So far, more than 5,500 Da Vinci robots, manufactured by California-based tech giant ‘Intuitive’ have been installed globally. The system is deployed in a range of procedures with the biggest impact in urology for robot-assisted radical prostatectomies (RARP) - removal of the prostate and surrounding tissues for treatment of localized cancer. Prostate cancer is the second most common cancer amongst men worldwide.

According to WHO, cancer accounted for nearly 10 million deaths in 2020. As cancer treatment/management technologies evolve with newer methods of treatment and current therapies become more efficient through precision, intervention and medication, treatment/management outcomes will improve globally. Indian hospitals such as the Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), Fortis Hospital, and BLK Super Speciality have already adopted new developing technology such as robotic surgery, targeted medicines etc. These emerging technologies could revolutionize cancer treatment to a great extent and could become more cost-efficient with increasing acceptance and accessibility.

Dr. Rajesh Bollam is a European Certified Medical Oncologist, associated with the global telehealth platform, Docty.

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