Seeking ‘targeted cures’ for cancer

While most governments, especially in the developing world, are most concerned with common infectious diseases, the truth is that noncommunicable diseases or NCDs, also known as “lifestyle diseases,” are catching up in terms of incidence and fatalities.

These include heart and blood pressure conditions, related diseases like diabetes and kidney and lung ailments, and cancers. Of these, the word “cancer” conjures up the most dread. Indeed, cancer has been called “the emperor of all maladies,” largely because of its devastating toll on the health and survival of patients, and, despite the efforts of whole armies of doctors, researchers, and various experts, the lack of knowledge about cancer’s causes, progress and cure.

Dr. Christiane Hamacher, who heads the Asia-Pacific division of Roche Pharmaceuticals, laments the “high unmet medical need” of cancer patients in the region. There should be “better ways to prevent, diagnose and treat the disease,” she asserts, noting how it has been predicted that by 2035, there will be 22 million individuals with cancer and 14.5 million deaths, translated to 26 deaths per minute, worldwide.

The trouble is that, says Hamacher, it takes from 10 to 15 years for a cancer drug or therapy to be developed, tested, and approved. Even then, she says, at Roche “we don’t believe in a one-size-fits-all” cure, adding that their goal is “personalized healthcare” that will provide “each patient with individual therapy.”

Indeed, says Dr. Durhane Wong-Rieger, speaking on “understanding the cancer patient’s journey,” the patient should be seen as much more than a passive subject of care or a receptacle of therapies.

To be sure, says Wong-Rieger, a patient advocate, a goal of cancer care these days is “how to give patients a more active role” in their diagnosis, treatment and cure.

A basic need, though, is awareness since treatment begins with screening, which can only take place if a patient is proactive enough and has the necessary resources to seek a diagnosis, go for testing, accept the diagnosis, consider the treatment options (believe it or not, the patient has a choice), avail her/himself of post-treatment therapy, and continue monitoring.

The trouble is, says Wong-Rieger, in many societies “there isn’t a very strong belief in the right to health,” with few believing that the ideal of “universal healthcare” is a basic right.

Early diagnosis is the first and best step toward a cure, but too many patients seek a doctor’s opinion only when it is too late or the condition calls for treatment beyond conventional bounds. Another hindrance to treatment is the “lack of access to treatment options,” including delays in delivery of needed drugs, or access to services.

Patients’ rights advocates like her, says Wong-Rieger, have a “triple aim”: better care or access to care, improving the quality of life of cancer patients, and managing the tradeoffs inherent in treatment.

For Dr. Sivabalan Sivanesan, the regional director for oncology at Roche, the new frontier in cancer treatment lies in the development of individualized, targeted options tailored to every patient’s condition, cancer type and stage, much like “surgical strikes” seek maximum impact with minimal damage. This is in contrast to chemotherapy and radiation, the two most common treatments, which are akin to using “bombs” against specific (even hidden) targets on the ground.

The current “snapshot” of cancer survival rates using chemotherapy only, says Sivanesan, shows that the “clinical benefits” of the treatment fall over time, at times with sudden precipitous drops. But with

the use of “targeted agents” such as immunotherapy, the drop in efficacy is much more gradual over a longer time—though their goal, says Sivanesan, is for the clinical benefits to hold steady over time.

But the problem, says Sivanesan, is that “cancer is a complex condition,” with more than 250 types identified so far. Which is why there is a crying need for individualized, personalized care, since there can be variations even within the same type of cancer.