Indian oncologists are now increasingly eyeing novel therapeutic approaches like use of systemic therapy along with invasive in axillary dissection and molecular diagnostics to stall the morbidity of breast cancer (BC). This is because of aggressive cancers manifesting in the young age group.
Currently, incidence of BC among young women is around 1.7 million new cases diagnosed yearly with an annually fatality reported at 5,20,000.
Newer drugs for BC are Pertuzumab from Genentech, Palbociclib: Pfizer, Everolimus: Novartis, Abraxane: Abraxis Bioscience, Ado-Trastuzumab Emtansine from Genentech, Ribociclib from Novartis & Astex, Neratinib Maleate by Puma Biotechnology and Abemaciclib from Lilly. There are over 260 ongoing clinical breast cancer trials in India. The challenge is lack of awareness and reporting any changes on time to a doctor . It is here that late detection directly decreases long term survival of the patient, Dr. D G Vijay – Consultant – Surgical Oncology, HCG Cancer Centre told Pharmabiz.
Added to this are the limited trained human resources such as surgeons, medical and radiation oncologists besides treatment cost and accessibility, he added.
On the occasion of the breast cancer month observed in October annually, oncologists are concerned on the outcomes which are not favourable in young women because of late diagnosis and detection in advanced disease.
Concerned that BC is engulfing a relatively younger population, Dr. Chirantan Bose, vice president, clinical services, MedGenome said that by 2020, India would be home to the largest young population globally. Indian statistics on BC indicate that one in every 2 newly diagnosed cases succumbs to it compared to US where one out of 6 newly diagnosed report fatality due to malignancy and China one in four new cases also succumb to this disease. “Therefore these three countries constitute the maximal global burden of mammary malignancy. This is a grim picture because in India cases are detected at relatively late or advanced stages.”
According to Dr Suraj Manjunath, Chief Surgical Oncologist, Vikram Hospital, recent advances in surgery like organ preseration, use of local tissue flaps in oncoplasty which are cosmetic outcomes are much better than ever before.
Access to less invasive in axillary for armpit dissection during or the sentinel node concept prevents side effects of surgery like arm swelling and impaired shoulder movements, he added.
For Dr. Bose molecular diagnostics and targeted therapy have ushered a new era in the management of cancer. For instance, advanced genetic tests enable not just early detection but track the evolution and response to specific treatments. Further, genetic testing enables screening of unaffected family members when high risk genetic variants are detected. The age old practices of cytotoxic chemotherapy with its horrendous complications are replaced with the evolution of molecular targeted therapy.
Recent therapeutic advances in targeted treatment by PARP inhibitors enhances survival of otherwise poor prognosis BRCA positive patients. Immunotherapy enables the immune system to prevent cancerous growth. Of late, there are several successful trials that have finally set the stage for immunotherapy as the line of treatment. The recent FDA approval to Pembrulizumab is a significant move in this direction. The combination of advancements in molecular diagnostics clubbed with discoveries of target molecules which can selectively impact cancer cells makes the onerous route of cancer treatment much easier and successful in future, stated Dr. Bose.