With more than one million new cases of breast cancer being diagnosed annually, oncologists endorse Targeted Molecular Therapy (TMT) with monoclonal antibody (MAb) drugs as the best method to save the organ with lower side effects of surgery and chemotherapy.
The MAb drugs are designed to attack tumours. Most promising results have been seen in advanced cases where TMT in conjunction with radiotherapy has improved response and survival rates compared to conventional modalities like surgery, chemotherapy, radiotherapy and hormones.
"TMT blocks the blood vessel and starves the cancer cells. There are no side effects and TMT acts with or without chemotherapy on any metastatic condition, informed Dr SP Somashekar, surgical oncologist, Manipal Hospital.
Although, TMT is known to increase the immunity response levels, the cost is the biggest deterrent. At a government hospital like ours we are forced to opt for chemotherapy, stated Dr P Bapsy, director, Kidwai Memorial Institute of Oncology.
Dr Uday Kumar, Maiya, consultant radiologist, Bangalore Hospital recommends an individual cocktail of MAb drugs with less toxicity to eliminate chemotherapy.
Global cancer drug market size is estimated to be $35 billion and India it is Rs 800 crore. Roche, GSK, Novartis, Pfizer, sanofi-aventis, Bristol Myers Squib and AstraZeneca are the major players in the breast cancer drug segment. This has led to a monopolistic situation resulting in high pricing primarily due to the patent protection. However, prices are definitely going to come down looking at the competitive market dynamics, stated Dr Somashekar. Indian companies like Biocon, Dabur, Intas, Dr Reddy's are undertaking several research initiatives and making efforts to launch drugs which could bring down cost by one third or half the cost, he added.
The leading breast cancer drugs are Avastin, an anti VEGFR (vascular epidermal growth factor receptor) by Roche priced at priced at Rs 1.2 lakh for a month's treatment. The entire treatment works out to Rs 6 to 11 lakh. Herceptin by the same company is considered a revolutionary treatment option for patients with anti-Her-2-neu antibody because it acts against the growth factor. Thirty percent of the breast cancer cases are diagnosed with high levels of human EGFR 2 (HER-2), which is associated with aggressive disease and a poor prognosis. Therefore, several anticancer drugs are designed to target HER-2.
GlaxoSmithKline's Tykerb (Lapatinib) is the first drug to target both HER2 and HER1, setting it apart from AstraZenenca's Iressa (gefitinib), which is a small molecule kinase inhibitor that only targets HER1, informed sources from the Thiruvananthapuram-based Rajiv Gandhi Centre for Biotechnology.
Onco-scientists are developing angiogenesis inhibitors or anti-angiogenesis drugs like anti VEGFR to invade the primary tumour site.
A hormone therapy for the ER/PR positive cases with AstraZeneca's Faslodex, a once a week drug priced at Rs 15,000 is prescribed when the mainline therapy fails.
World Health Organization reports more than one million new cases diagnosed annually. The global incidence is 67 per one lakh women. In India, cancer of the breast is the second highest after cervix affecting 25 in one lakh population (cities) and 6 per one lakh (villages). Causes are high fatty diets, delayed pregnancies resulting in short spans of breast feed and use of oral contraceptives, stated Dr Bapsy.
Only early detection could result in faster cure with less modalities that would ensure economical breast cancer treatment, said Dr Maiya.