Cancer has become of the dreadful diseases of all times as more and more people are affected by this disease every year. It is not a disease of elderly only. Dr. Waseem Abbas, Associate Consultant - Medical Oncology, Max Super Speciality Hospital, Shalimar Bagh, believes that time has come for newer and effective therapies where we all should unite and conquer the disease, which is possible only with Innovation.
What are Innovative therapies?
A. The cancer research field is filled with promising innovators looking for new and exciting ways to treat and prevent cancer, as well as improve conditions for patients during and after treatment.
B. Medical innovation is about experimentation and challenging the status quo. Sometimes that involves simply thinking outside the box and sometimes it means bucking conventional wisdom outright.
C. Or it simply means invention and discovery of new drugs which are less toxic, prolong life and cure cancer or are affordable to all.
Nevertheless, every year brings new knowledge and insights that help direct further research and ultimately improve the outlook for patients with cancer. In this article, Dr. Waseem has highlighted the most important clinical advances of the past few years and previews where cancer science is headed.
Liquid biopsies for Circulating Tumor DNA;- Oncologists have long dreamed of avoiding the subjective nature of reported signs and the hit-or-miss nature of biopsies. Their dreams may be coming true. Blood tests known as “liquid biopsies” uncover signs of actual DNA, or cell-free circulating tumor DNA (ctDNA), which is shed from a tumor into the bloodstream. The advantage is that ctDNA is more than 100 times more abundant in the blood than tumor cells. We now routinely do this test and avoid repeat biopsies which are painful and risky. Liquid biopsies now offer standard care in some cancers.
What is cancer Immunotherapy?
Types of immunotherapy: Immunotherapy is a treatment that uses certain parts of a person’s immune system to fight diseases such as cancer. This can be done in a couple of ways:
- Stimulating your own immune system to work harder or smarter to attack cancer cells
- Giving your immune system components, such as man-made immune system proteins.
· The immune system keeps track of all of the substances normally found in the body. Any new substance that the immune system doesn’t recognize raises an alarm, causing the immune system to attack it. For example, germs contain substances such as certain proteins that are not normally found in the human body. The immune system sees these as “foreign” and attacks them. The immune response can destroy anything containing the foreign substance, such as germs or cancer cells.
· The immune system has a tougher time targeting cancer cells, though. This is because cancer starts when cells become altered and start to grow out of control. The immune system doesn’t always recognize cancer cells as foreign.
· Clearly there are limits on the immune system’s ability to fight cancer on its own because many people with healthy immune systems still develop cancer. Sometimes the immune system doesn’t see the cancer cells as foreign because the cells aren’t different enough from normal cells. Sometimes the immune system recognizes the cancer cells, but the response might not be strong enough to destroy cancer. Cancer cells themselves can also give off substances that keep the immune system in check.
· To overcome this, researchers have found ways to help the immune system recognize cancer cells and strengthen its response so that it will destroy them.
The main types of immunotherapy now being used to treat cancer include:
- Monoclonal Antibodies: These are man-made versions of immune system proteins. Antibodies can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.
- Immune checkpoint Inhibitors: These drugs basically take the ‘brakes’ off the immune system, which helps it recognize and attack cancer cells.
- Cancer Vaccines: Vaccines are substances put into the body to start an immune response against certain diseases. We usually think of them as being given to healthy people to help prevent infections. But some vaccines can help prevent or treat cancer.
- Other, non-specific immunotherapies: These treatments boost the immune system in a general way, but this can still help the immune system attack cancer cells.
Here Dr. Abbas mentions that for the treatment of lung cancer prognosis used to be dismal and we had nothing to offer to the patient except chemotherapy but with the advent of immunotherapy patients do better and live longer with fewer side effects as well.
Cellular Immunotherapy to treat Leukemia and Lymphoma: Chimeric antigen receptor (CAR) T-cell therapies represent a type of immunotherapy where a patient’s immune system T-cells are removed and genetically reprogrammed to seek and destroy tumor cells. They seek out antigens, multiply, and attack and kill the foreign cancer cells, often stick around to minimize chances of relapse. Results of these cellular immunotherapies have been impressive. Some studies focusing on acute lymphoblastic leukemia (ALL) have reported a remission rate of 90%.
The groundbreaking treatment is expected to be presented to the FDA in 2017 for treatment of ALL, which could trigger a wave of approvals for other blood cancers and lymphomas. Cellular immunotherapy could one day replace chemotherapy and its lifetime of side effects. It gives a body a chance to prove resilience. Already it has been approved for pediatric ALL.
- Molecular cancer diagnostics: Companies like Foundation Medicine are creating customized treatment plans based on the genetic makeup of the patient’s tumour. They sequence DNA from the patient’s tumor, and try to match the key mutations to drugs on the market or clinical trials already on the way. Over time, this will become the standard for assigning cancer treatment regimes. And we have started doing it in India and are on the learning curve.
- Artificial intelligence based therapy design: DNA cages
Most cancer treatments today destroy not only cancerous cells but also healthy ones. The ultimate goal is delivering drugs only to cells that need to be treated. Using DNA cages holding a payload of drugs might be the answer. This method could be used in clinical trials soon. Cancer cells can trigger the DNA cage to open and thus the drug could only make an impact on those cells, but not the healthy ones.
- Precision surgery: Surgeons using surgical robots such as DaVinci are capable of performing operations with previously unachievable precision. By making the robot an extension of the surgeon’s mind and skills, operating tumors in early stages, or tumors in close proximity to sensitive organs might become more feasible than ever.
- Precision Radiotherapy: Accounting for temporal anatomic changes in thoracic and abdominal cancer radiotherapy is one of the key scientific and clinical challenges of our era. These anatomic changes reduce image quality and targeting accuracy, which in turn lead to geometric and dosimetric errors in treatment. Such errors become increasingly important as we move toward hypofractionated regimens, such as stereotactic ablative radiotherapy, where highly potent doses are administered to the tumor target in a few fractions. Thoracic anatomy changes in all four dimensions (4D = 3D + time) from cycle to cycle and day to day. A common limitation of current motion management techniques is that they neither discard large amounts of this 4D information or capture it nor adequately account for cycle-to-cycle variations. The goal of our motion management research is to capture and account for all four dimensions at each radiotherapy step: simulation, treatment planning, and dose delivery. We use high-performance CPU and GPU computing to:
- Create patient-specific, parameterized volumetric motion models that describe the underlying patient anatomy as a function of the optical surface over many breathing cycles.
- Investigate higher-order inverse planning strategies using GPU-based swarm optimization algorithms to create truly 4D-optimized treatment plans that use motion as an additional degree of freedom in the optimization process and
- Track real-time motion using a dynamic multileaf collimator that reshapes the beam to follow all of the complex changes (translation, rotation, and deformation) of the tumor and surrounding organs.
- Next-generation targeted therapies: New approaches in the field of systems biology that use computer models to predict therapy effects are promising to cut through this complexity, and deliver effective combinational therapies in the coming years. All the while, new approaches like immunotherapies put emphasis on making the patient’s immune system sensitive to cancer cells again, this way letting the immune system fight back.
All these technologies show amazing promise and some of them are already in use. We need to keep on pushing the limits to get to a stage where the diagnosis of cancer is not a life-altering event that often brings an untimely end to a patient’s life, but at least a manageable, chronic condition.