World Cancer Day: Immunotherapy can help patients suffering from carcinoma of the lungs
Immunotherapy should be given as early as possible to achieve a lasting remission of the disease.
By ET CONTRIBUTORS |
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By Dr Vijay Agarwal
Lung cancer is one of the leading causes of cancer incidence & mortality in India and across the world, according to GLOBOCAN 2018. Lung cancer has different types - adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Previously, survival from advanced stage of lung cancer was poor with median life expectancy measured in a few month, and chemotherapy was the primary treatment.
Immunotherapy: New hope Over the past 5 years, research shows that immunotherapy has significantly helped lung cancer patients.
Immunotherapy is the use of drugs designed to enhance the effectiveness of the body's own immune system against the cancer cells. Immunotherapy has been used for over 5 decades to treat various types of cancers, but the recent developments of check point inhibitors have shown promising results.
Metastatic Cancer: Myths Vs Facts
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Metastatic cancer, also known as advanced-stage cancer, starts in one organ and then spread to other organs of the body.
Dr Rucha Kaushik, Consultant, Breast Cancer Surgeon, P D Hinduja Hospital & MRC busts some myths associated with high-grade cancer.
Metastatic cancer, also known as advanced-stage cancer, starts in one organ and then spread to other organs of the body.Dr Rucha Kaushik, Consultant, Breast Cancer Surgeon, P D Hinduja Hospital & MRC..
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Fact: Treatment decisions are to be made in consultation with expert clinician after diagnosing the appropriate stage of the cancer. Once diagnosed, treatment protocol should to be followed as per recommendation.
Fact: Treatment decisions are to be made in consultation with expert clinician after diagnosing the appropriate stage of the cancer. Once diagnosed, treatment protocol should to be followed as per re..
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Fact: Biopsy is mandatory to diagnosis the exact of cancer type, grade, and aggressiveness of the tumour. Biopsy helps in understanding the kind of treatment that the cancer will respond to better.
Fact: Biopsy is mandatory to diagnosis the exact of cancer type, grade, and aggressiveness of the tumour. Biopsy helps in understanding the kind of treatment that the cancer will respond to better.
Fact: The treatment depends on the stage of cancer at the time of diagnosis and the organ(s) involved. The combination of chemotherapy, surgery and radiotherapy form the treatment protocol. Nothing about the treatment is aggressive or non-aggressive. All cancers to be treated with utmost care.
Fact: The treatment depends on the stage of cancer at the time of diagnosis and the organ(s) involved. The combination of chemotherapy, surgery and radiotherapy form the treatment protocol. Nothing a..
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Fact: Cancer isn't a death sentence. Early detection saves life. Diagnosis at early stage gives better chances of complete cure.
Fact: Cancer isn't a death sentence. Early detection saves life. Diagnosis at early stage gives better chances of complete cure.
How checkpoint inhibitors work Essentially, checkpoints are the brakes applied to the immune system, thereby preventing it from attacking its own healthy cells and tissues. However, these checkpoint signals are enhanced in some cancers that prevent the body's immune system from destroying cancer cells. Checkpoint inhibitors release these brakes in a controlled manner, enabling the immune system to recognise and eliminate these cancer cells.
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The most important checkpoints PD1/PDL1 and CTLA-4 were identified by Tasuku Honjo and James P Allison who won the 2018 Nobel Prize in Physiology or Medicine for their discoveries.
Checkpoint inhibitors against PD1/PDL1 have shown remarkable benefit in almost all types of lung cancer. Certain types of lung cancer have gene defects like mutations, translocations, amplifications which act as drivers for propagating the cancer cells. Various targeted therapies exist for these specific genes and whenever a specific gene defect if identified, a specific targeted therapy is used. However, for the vast majority of lung cancer patients, these drivers are not present.
All of these patients are technically eligible for immunotherapy either on its own or in combination with chemotherapy irrespective of type of lung cancer. PDL1 testing is now a routine practise in most cancer centres, and immunotherapy with or without chemotherapy is planned depending up on the results.
Lung cancer: Treatment options In advanced lung cancer, chemotherapy has a modest benefit with most patients surviving only a few months to a year. Chemotherapy should no longer be considered a standard of care.
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Now, immunotherapy is changing the landscape of lung cancer treatment. Most patients without cancer drivers should be offered immunotherapy, which is a new, standard treatment as per international American and European guidelines.
Keep Cancer At Bay: Eat Garlic, Turmeric And Other Anti-Carcinogenic Foods
While one can never be sure what can trigger the onset of this deadly disease, it is important to take necessary precautions to stay safe. There are certain food items that have anti-carcinogenic properties, and can help in keeping cancer at bay.
These herbs and spices from your kitchen cabinet can boost your immune system to keep the deadly disease at bay.
Dr Manoj Kutteri, Director of Atmantan Wellness Centre, shares a list of ingredients that can help your fight the illness.
Bollywood actress Sonali Bendre has been undergoing treatment in New York after being diagnosed with metastatic cancer.
While one can never be sure what can trigger the onset of this deadly disea..
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A number of studies have shown that curcumin (yellow chemical compound in turmeric) has got anti-cancerous properties. It has the ability to kill cancer cells and prevent more from growing. Curcumin inhibit growth of various cancer cells in bone, breast, brain, colon, stomach, bladder, kidney, prostate and ovary. It can also kill the cancer cells by apoptosis (a programmed cell death).
A number of studies have shown that curcumin (yellow chemical compound in turmeric) has got anti-cancerous properties. It has the ability to kill cancer cells and prevent more from growing. Curcumin ..
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Ginger has been considered ten thousand times more powerful than chemotherapy for the treatment of cancer. It is an anti-oxidant and a natural cancer fighter. The active compounds 6-gingerol and 6-shogaol exhibit anti-cancer properties against the gastrointestinal tract and helps in cancer cell death.
Ginger has been considered ten thousand times more powerful than chemotherapy for the treatment of cancer. It is an anti-oxidant and a natural cancer fighter. The active compounds 6-gingerol and 6-sh..
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Garlic is another most important spice that is used in treating cancer. It has the ability to inhibit the production of cancer-causing properties, speed up the repairing process of DNA and to decelerate the proliferation of cancer cells.
Garlic is another most important spice that is used in treating cancer. It has the ability to inhibit the production of cancer-causing properties, speed up the repairing process of DNA and to deceler..
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Black pepper contains anti-oxidant piperine. A study conducted in Michigan's cancer institute concluded that the black pepper along with turmeric can prevent the growth of cancerous stem cells in breast tumours.
Black pepper contains anti-oxidant piperine. A study conducted in Michigan's cancer institute concluded that the black pepper along with turmeric can prevent the growth of cancerous stem cells in bre..
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This aromatic herb used inn pizzas contain an active ingredient known as carvacrol, which is proven to be beneficial in treating prostate cancers. The oregano oil has the ability to selectively kill the cancer cells while leaving the healthy cells intact.
This aromatic herb used inn pizzas contain an active ingredient known as carvacrol, which is proven to be beneficial in treating prostate cancers. The oregano oil has the ability to selectively kill ..
The current standard is to use immunotherapy in stage 3 and 4 of lung cancer. Whilst the evidence for role of immunotherapy in lung cancer is exciting and most patients should be eligible for it, it is not a cure, but merely an extension of good quality life. Immunotherapy, though well-tolerated, it has its own share of side-effects, which can be easily managed.
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Immunotherapy: Scope in India Currently three drugs are available in India - Pembrolizumab (Keytruda®), Nivolumab (Opdivo®, Opdyta®) and Atezolizumab (Tecentriq®) - that are approved by Drug Controller General of India for stage 4 lung cancer patients.
Recently, another checkpoint inhibitor - Durvalumab (Imfinzi®) - showed efficacy in stage 3 inoperable lung cancer. The drug will be launched in India soon.
Immunotherapy: Timing is important The timing of use of immunotherapy is very important. Immunotherapy should be given as early as possible to achieve a lasting remission of the disease. Most patients with non-driver mutation advanced lung cancer should be eligible for immunotherapy as initial treatment (either on its own or along with chemotherapy) depending upon PDL1 status of the tumour cells.
If the patient has not received immunotherapy as initial treatment, it can be given subsequently as there is good evidence of its use in all stages of treatment, as long as the patient is fit for it. Despite immunotherapy being very promising, it benefits only a small percentage of patients. However, in patients who respond to the treatment, the response may be durable and long lasting.
Various efforts are underway to improve the response rates of immunotherapy. Appropriate patient selection and identifying the right molecular markers are key to immunotherapy success. One of the ways of improving the response is to combine immunotherapy with chemotherapy, radiotherapy and other targeted therapies.
Over the next few years, we are likely to see more use of immunotherapy with appropriate patient selection, making it a standard treatment in more than 50% of the lung cancer patients.
(The author is Lead & Senior Consultant - Medical Oncology and Haematology, Aster CMI Hospital, Bangalore)
Celebs Who've Fought Serious Illnesses And Inspired Us To Stay Strong
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If you felt like tearing up after having seen Sonali Bendre's Instagram post on Tuesday where she quotes Chilean author Isabel Allende on staying strong, and chops off her tresses, you are not alone.
Many, including her compatriots from the industry and well-wishers, have been feeling emotional and wished her a speedy recovery. But the 44-year-old actress is not the only one who has managed to stay strong in the face of adversity.
Over the past decade, a few others have shown amazing courage and grace while battling medical conditions in real life, and proving to be a source of source of inspiration for their fans.
From Salman Khan to Yuvraj Singh, and Irrfan Khan, we stay inspired by some extraordinary stories of hope and strength.
If you felt like tearing up after having seen Sonali Bendre's Instagram post on Tuesday where she quotes Chilean author Isabel Allende on staying strong, and chops off her tresses, you are not alon..
Earlier this month, Bollywood actress Sonali Bendre revealed that she was undergoing treatment for metastatic cancer, also known as high-grade cancer, in New York. The 43-year-old has shown tremend..
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Earlier in March this year, actor Irrfan Khan revealed on social media in a series of posts that he had been diagnosed with NeuroEndocrine Tumour. The 51-year-old actor is presently undergoing treatment for the same in London.
Right after the reports came out, Shah Rukh Khan rushed to the ailing actor's residence to meet him before he left for his treatment in London. The superstar also gave him the keys to his London house so that Irrfan's family could feel at home during the treatment.
Earlier in March this year, actor Irrfan Khan revealed on social media in a series of posts that he had been diagnosed with NeuroEndocrine Tumour. The 51-year-old actor is presently undergoing trea..
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Bollywood actor Salman Khan has also had a second coming of sorts. The 'Dabangg' actor had been diagnosed with the neuropathic disorder, Trigeminal Neuralgia, in 2007. Also called as the 'suicide disease', the pain in the face, jaw and cheek gets intense and severe. The actor underwent a nerve surgery in the US in 2011 and was back shooting for 'Ek Tha Tiger'.
Bollywood actor Salman Khan has also had a second coming of sorts. The 'Dabangg' actor had been diagnosed with the neuropathic disorder, Trigeminal Neuralgia, in 2007. Also called as the 'suicide d..
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Away in Hollywood, it was bad news for Hugh Jackman's fans. In 2016, 'The Wolverine' star went through the fourth procedure for skin cancer on his nose. The actor first came to know about basal-cell carinoma, the mildest form of cancer, in November 2013. The actor has time and again asked his fans on social media to wear sunscreen to safeguard cancer.
Away in Hollywood, it was bad news for Hugh Jackman's fans. In 2016, 'The Wolverine' star went through the fourth procedure for skin cancer on his nose. The actor first came to know about basal-cel..
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Bollywood actress Manisha Koirala was diagnosed with ovarian cancer in 2012. The actress immediately went to the US for her treatment, and was declared cancer-free for about two years in 2015. Recently, she made a comeback as Nargis Dutt on the big screen in Raju Hirani's blockbuster 'Sanju'.
Bollywood actress Manisha Koirala was diagnosed with ovarian cancer in 2012. The actress immediately went to the US for her treatment, and was declared cancer-free for about two years in 2015. Rece..
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Yuvraj Singh, too, has fought all odds and showed grit, away from the field. The cricketer was diagnosed with mediastinal seminoma, a germ-cell tumour located between his two lungs, after the 2011 ICC World Cup. Initially, the cricketer did not believe the doctors and continued to play, which deteriorated his health further. He underwent chemotherapy in the United States in 2012. He also went through Ayurveda treatment and rehabilitation the same year. The sportsman also released an auto-biographical narrative 'The Test of My Life: From Cricket to Cancer and Back' in 2013.
In 2016, the cricketer married model-actress Hazel Keech. He has also invested in a series of health start-ups following his recovery.
Also see: All picture's from the couple's big, fat wedding
Yuvraj Singh, too, has fought all odds and showed grit, away from the field. The cricketer was diagnosed with mediastinal seminoma, a germ-cell tumour located between his two lungs, after the 2011 ..
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Bollywood megastar Amitabh Bachchan believes he was reborn on August 2, 1982, after his emergency surgery at the Breach Candy Hospital in Mumbai. The Big B had suffered splenic rupture due to an accident on the sets of Manmohan Desai's 'Coolie' in the University of Bangalore. During the surgery, the actor went into a coma due to the nature of the injury. Shortly after the 'Coolie' incident, he was diagnosed with a muscle dysfunctional disorder - Myasthenia Gravis. The condition makes it difficult for patients to perform simple tasks like brushing one's teeth, lifting arms, walking, etc. The 'Deewar' actor was treated with therapy and medicines, and recovered from the condition, but the doctors indicated that it can trigger any time.
Bollywood megastar Amitabh Bachchan believes he was reborn on August 2, 1982, after his emergency surgery at the Breach Candy Hospital in Mumbai. The Big B had suffered splenic rupture due to an ac..
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In 2013, Bollywood actor Hrithik Roshan underwent a successful brain surgery in Mumbai's Hinduja Hospital to remove a two-month-old blood clot. While performing stunts for his film 'Bang Bang', the actor had suffered head injuries. He then took pain-killers to fight the pain, but that didn't work. After the two-hour long operation, the 'Krrish' star was discharged with in three days, and was advised bed rest for a bit.
In 2013, Bollywood actor Hrithik Roshan underwent a successful brain surgery in Mumbai's Hinduja Hospital to remove a two-month-old blood clot. While performing stunts for his film 'Bang Bang', the..
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In 2009, model-turned-actress Lisa Ray was diagnosed with a rare disease - multiple myeloma, a cancer of the white blood cells known as plasma cells, which produces antibodies. In 2010, she announced that she was cancer-free, after a stem cell transplant. Two years on, she got married to Jason Dehni, a banking executive and philanthropist, in the Napa Valley.
In 2009, model-turned-actress Lisa Ray was diagnosed with a rare disease - multiple myeloma, a cancer of the white blood cells known as plasma cells, which produces antibodies. In 2010, she announc..
(Disclaimer: The opinions expressed in this column are that of the writer. The facts and opinions expressed here do not reflect the views of www.economictimes.com.)
