And Where India Stands

CAR T-Cell Therapy

CAR T-cell therapy is a revolutionary form of cancer treatment that harnesses the power of a patient's immune system to fight cancer. This therapy involves collecting T cells from a patient's blood and genetically engineering them in a laboratory to produce chimeric antigen receptors (CARs) on their surface. These receptors are designed to recognize specific proteins (antigens) found on the surface of cancer cells. Once the T cells are modified to express CARs, they are expanded to large numbers and infused back into the patient. The engineered T cells then seek out and bind to the cancer cells through these receptors, leading to the destruction of the cancer cells.

• Technology: T cells are genetically engineered to produce chimeric antigen receptors (CARs) on their surface, enabling them to recognize and attack cancer cells. The process involves extracting T cells from a patient, genetically modifying them to express CARs that recognize cancer cell antigens, and reinfusing them into the patient.
• Makers: Novartis and Gilead Sciences (Kite Pharma) are prominent manufacturers with FDA-approved CAR T-cell therapies, Novartis for tisagenlecleucel (Kymriah) and Gilead for axicabtagene ciloleucel (Yescarta).
• Introduced: Kymriah was first approved in 2017 in the USA for acute lymphoblastic leukemia.
• Related Treatments: Primarily used in hematological cancers such as certain leukemias and lymphomas where traditional treatments like chemotherapy have failed.

CRISPR Gene Editing

CRISPR Gene Editing stands as a groundbreaking technology in precision medicine, enabling scientists to edit parts of the genome by removing, adding, or altering sections of the DNA sequence. It's particularly promising in oncology for its potential to precisely alter immune cells to fight cancer more effectively. The technology is still in its developmental phase, with companies like CRISPR Therapeutics leading the way in exploring its full potential in clinical settings.

• Technology: Utilizes the CRISPR-Cas9 system to edit genes within immune cells to better target cancer. The CRISPR tool consists of two main actors: a guide RNA and a DNA-cutting enzyme, most commonly one called Cas9. Scientists design the guide RNA to mirror the DNA of the gene to be edited (called the target). The guide RNA partners with Cas and—true to its name—leads Cas to the target. When the guide RNA matches up with the target gene's DNA, Cas cuts the DNA.
• In Development: Multiple institutions and biotech companies, including CRISPR Therapeutics and Intellia Therapeutics, are conducting clinical trials.
• Related Treatments: Potential applications in solid tumors and genetic diseases where conventional treatments are inadequate.

PARP Inhibitors

PARP inhibitors target a specific weakness in certain cancer cells related to DNA repair mechanisms. By inhibiting the PARP enzyme, these drugs prevent cancer cells from repairing their DNA, causing them to die. This approach has been particularly effective in treating cancers that have mutations in BRCA genes, such as ovarian and breast cancers. Drugs like olaparib have been pioneers in this class, offering new hope for patients with specific genetic profiles.

• Technology: Drugs that inhibit the PARP enzyme, which helps repair DNA damage in cells. By inhibiting PARP, cancer cells with certain mutations cannot repair themselves and die.
• Makers: AstraZeneca (olaparib), Pfizer (talazoparib), and GlaxoSmithKline (niraparib) are the leading makers.
• Introduced: Olaparib was first approved in 2014 in the USA for ovarian cancer.
• Related Treatments: Aside from ovarian cancer, it is also used in breast, pancreatic, and prostate cancers that exhibit similar genetic vulnerabilities.

Checkpoint Inhibitors

Checkpoint inhibitors are a class of drugs that help unleash the immune system against cancer by blocking proteins that restrain immune responses, such as PD-1 and CTLA-4. These treatments have transformed the landscape of cancer therapy, offering substantial improvements in survival for patients with advanced melanoma, non-small cell lung cancer, and more. They are now integral to first-line treatments for several types of cancer.

• Technology: These immunotherapies inhibit the checkpoint proteins, which cancer cells use to protect themselves from being attacked by the immune system.
• Makers: Merck (pembrolizumab, Keytruda) and Bristol Myers Squibb (nivolumab, Opdivo) are leading manufacturers.
• Introduced: Keytruda and Opdivo were approved in 2014 for melanoma.
• Related Treatments: Now used widely in non-small cell lung cancer, renal cell carcinoma, head and neck cancers, and more, often in combination with other therapies.

AI in Diagnostic Imaging

Artificial intelligence in diagnostic imaging leverages complex algorithms to improve the accuracy and efficiency of interpreting medical images. This technology enhances the ability of clinicians to diagnose cancer at earlier stages and with greater precision, facilitating timely and targeted treatment strategies. Innovations by IBM Watson Health and Google DeepMind exemplify the strides being made in integrating AI into everyday clinical practice.

• Technology: AI algorithms enhance the precision and speed of cancer diagnosis through imaging technologies like MRI and CT scans.
• Developers: IBM Watson Health and Google DeepMind are key players in developing AI for healthcare applications and Siemens is a leading manufacturer.
• Current Status: Ongoing implementation in diagnostic centers worldwide, significantly expanding since the 2020s.
• Related Treatments: Used across various types of cancers for diagnosis, monitoring treatment responses, and planning surgical or radiation treatments.

Liquid Biopsy

Liquid biopsy is a transformative diagnostic approach that detects cancer information through a simple blood test, identifying circulating tumor DNA. This non-invasive method allows for early detection of cancer, monitoring of treatment progress, and detection of recurrence without the need for traditional biopsy procedures. It represents a significant advance in personalized oncology, enabling ongoing adjustments to treatment plans based on real-time tumor dynamics.

• Technology: Detects circulating tumor DNA (ctDNA) in blood samples, offering a non-invasive diagnostic and monitoring solution.
• Makers: Guardant Health and Grail are leading companies providing liquid biopsy tests.
• Current Status: Tests like Guardant360 have been available and improving since the early 2010s.
• Related Treatments: Useful in lung cancer, colorectal cancer, and melanoma, particularly for detecting mutations and monitoring for recurrence.

Targeted Radiation Therapy (Proton Beam Therapy)

Targeted radiation therapy, such as proton beam therapy, offers a precision-focused treatment option that minimizes damage to surrounding healthy tissues. This method is particularly beneficial for treating cancers located near critical organs and for paediatric cancers, where limiting long-term damage is crucial. Proton therapy's ability to deliver high radiation doses directly to tumor sites underscores its importance in modern radiation oncology.

• Technology: Uses a beam of protons to deliver radiation directly to the tumor, minimizing damage to surrounding tissue.
• Makers: Siemens Healthineers and Hitachi provide proton therapy systems.
• Introduced: The use of proton therapy has been expanding since the early 2000s, with facilities now in many countries including the USA, Japan, India and several European nations.
• Related Treatments: Particularly effective in treating pediatric cancers, brain tumors, and cancers close to critical organs.

Bispecific Antibodies

Bispecific antibodies are innovative cancer treatments designed to engage two different targets simultaneously, typically one on cancer cells and another on immune cells. This dual targeting prompts the immune system to attack the cancer more effectively. Still in clinical trials, these therapies hold promise particularly for treating various types of leukemia and are being explored for potential use in solid tumors.

• Technology: Engineered antibodies designed to engage two different targets simultaneously, such as a cancer cell and an immune cell.
• In Development: Roche and Amgen are among the companies developing these treatments. Several bispecific antibodies are in clinical trials.
• Related Treatments: Being tested in leukemia and lymphoma, with research extending to solid tumors.

Theranostics

Theranostics combines therapeutic and diagnostic functionalities into a single agent, typically using targeted radiolabeled compounds that seek out and treat cancer cells while also providing diagnostic imaging. This integrated approach facilitates highly personalized treatment plans, improving the precision and effectiveness of therapies, particularly in treating neuroendocrine tumors and potentially other cancers with distinct molecular targets.

• Technology: Combines diagnostics with therapeutic delivery tailored to the diagnostic result, using agents like radio-labeled compounds that target cancer cells.
• Makers: Advanced Accelerator Applications (a Novartis company) is a leader in this area, particularly with Lutathera for neuroendocrine tumors.
• Introduced: Lutathera was approved in 2018 in the USA for treating neuroendocrine tumors.
• Related Treatments: Expanding into prostate cancer and other cancers with specific molecular targets.

These technologies and treatments are at the forefront of oncology, potentially transforming cancer care by tailoring it more precisely to the genetic and molecular profiles of individual patients and their tumors.

India's rise as a global leader in oncology treatments is marked by its holistic approach to cancer care, incorporating the latest technological advancements, highly skilled medical professionals, and a growing reputation for clinical excellence. This robust development makes India an appealing destination for patients seeking high-quality, cost-effective cancer treatment from across the globe.

The country's healthcare system is known for its capacity to offer advanced treatments that rival those available in Western countries but at a fraction of the cost. Hospitals in India are equipped with state-of-the-art medical technologies such as the latest in CAR T-cell therapy, next-generation sequencing for personalized medicine, and cutting-edge radiation therapies like proton beam therapy.

CAR T-Cell Therapy

• Details: CAR T-cell therapy involves genetically modifying a patient's T cells to target and kill cancer cells. It has shown significant success in treating certain types of blood cancers such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma.
• Hospitals: This treatment is available at hospitals such as Kokilaben Dhirubhai Ambani Hospital and Jaslok Hospital in Mumbai, Continental Hospital in Hyderabad, and at select Apollo Hospitals across India. These institutions have the infrastructure and specialized personnel required to handle the complex process of cell collection, modification, and reinfusion.

PARP Inhibitors

• Details: PARP inhibitors are used to treat cancers that have specific genetic mutations, such as those involving the BRCA genes. They are particularly effective in treating ovarian, breast, and prostate cancers.
• Hospitals: Widely available in most leading cancer treatment centers across Mumbai, Hyderabad, Chennai and New Delhi. These hospitals have oncology departments well-equipped to manage and monitor patients undergoing treatment with PARP inhibitors.

Checkpoint Inhibitors

• Details: Checkpoint inhibitors are a type of immunotherapy that helps the immune system recognize and attack cancer cells. They are used in the treatment of various cancers, including melanoma, lung cancer, and kidney cancer.
• Hospitals: Available at major healthcare providers such as Apollo Hospitals, Max Healthcare, and Fortis Healthcare. These hospitals have comprehensive cancer care facilities that include immunotherapy as a key component of cancer treatment protocols.

AI in Diagnostic Imaging

• Details: AI technologies are used to enhance the accuracy of diagnosing cancers through imaging techniques like MRI and CT scans. They help in identifying cancerous growths earlier and with greater precision, leading to better treatment outcomes.
• Hospitals: Kokilaben Dhirubhai Ambani Hospital, Narayana Health, Medanta, and Continental Hospitals are some of the hospitals that integrate AI with diagnostic imaging, providing state-of-the-art diagnosis facilities that support early and accurate detection of cancer.

Liquid Biopsy

• Details: This is a non-invasive test that detects cancer DNA in blood samples. It is used for diagnosing cancer, monitoring treatment progress, and detecting recurrence. It's particularly useful in cases where traditional biopsy is not feasible.
• Providers: Available through specialized diagnostic labs at hospitals like Yashoda Hospitals and Continental Hospitals in Hyderabad, and Global Hospitals and Jaslok Hospital in Mumbai. These facilities offer advanced genetic testing services that aid oncologists in making informed treatment decisions based on dynamic tumor profiling.

Targeted Radiation Therapy (Proton Beam Therapy)

• Details: Proton beam therapy is a type of radiation treatment that uses protons instead of X-rays to treat cancer. It allows for more precise targeting of tumors, reducing damage to surrounding healthy tissues.
• Facilities: The Apollo Proton Cancer Centre in Chennai is one of the pioneering centers in India offering this advanced form of radiation therapy. It provides a cutting-edge option for patients, especially those with complex or hard-to-reach tumors. Nanavati Max Hospital in Mumbai and Medicover Hospitals and Citizens Hospital in Hyderabad are also equipped with providing advanced Proton Beam Therapy.