COVER STORY
30 THE WEEK · JULY 29, 2018
HEALTHsays Bajpai, professor at the Tata Memorial
Hospital. “Now, he is in remission. We will
be monitoring him for several years. The fi rst
two years are critical as that's when the disease
might come back.”
Immunotherapy, she says, has been approved
for nine types of cancer now. It has been found
to be effective in melanoma; in lung, bladder,
head and neck cancers, it's role has been de-
fi ned; in sarcomas, ovaries and breast cancer, it
is still in early stages of trials.
Several oncologists that we spoke to de-
scribed this mechanism as “exciting”, “revo-
lutionary” and even as a “paradigm shift”
in cancer treatment. And that, too, at an ad-
vanced stage, where conventional therapies
have failed.
“When it comes to cancers that are more ag-
gressive, in late stages, and in solid tumours
such as lung cancer, oesophageal cancer, liver
and brain, we have reached a plateau in cancer
treatments,” says Dr Rakesh Jalali, medical di-
rector, Apollo Proton Cancer Centre, Chennai.
“In the last fi ve to ten years, however, immuno-
therapy has ushered in a new revolution.”
For those who don’t have an option, for
whom all conventional treatments have failed,
immunotherapy is a “real breakthrough”
treatment.
The idea itself, says Jalali, is not really novel.
For centuries, it has been known that a strong
immune system can fi ght off cancer, and scien-
tists have been trying to harness the immune
system to do so.
Lately, they have had some success, especially
with checkpoint inhibitors that were approved
in 2011 and, more recently, with the chimeric
antigen receptor (CAR) T-cell therapy. Last
year, the US Food and Drug Administration
approved two CAR T-cell therapies, one for the
treatment of children with acute lymphoblastic
leukaemia, and other for adults with advanced
lymphomas. The therapy, used in blood can-
cers, requires drawing blood from patients
and separating out the T-cells. Then, using a
disarmed virus, the T-cells are genetically en-
gineered to produce receptors on their surface
called chimeric antigen receptors. These recep-
tors allow the T-cells to recognise and attach to
a specifi c protein, or antigen, on tumour cells.Once reengineered, these cells are multiplied in
the lab, and planted into the patient's body, where
they multiply further and kill cancer cells by rec-
ognising them through their receptors.
In India, checkpoint inhibitor therapy has made
its way in the last two years, and CAR T-cell ther-
apy research is still in its early days. “Unlike che-
motherapy, where we attack the cancer cells with
drugs, and work on the maximum tolerance limit
of the body, in immunotherapy we are simply bol-
stering the immune system to fi ght cancer,” says
Dr Gaurav Narula, professor, paediatric oncology
and convener, Pediatric Hemato-lymphoid Group
at Tata Memorial Centre, Mumbai, who has
been working on the CAR T-cell therapy in India,
along with his partner in IIT Bombay. Globally,
the therapy has found some success in about 15
per cent of blood cancers that do not respond to
chemotherapy.
The advantage of immunotherapy against con-
ventional treatments lies in its reduced toxicity,
says Dr Vinod Raina, head of department and
director of medical oncology and haematology,
Fortis Memorial Research Institute, Gurugram.We need to collaborate
with the global commu-
nity, and be intellectu-
ally honest about the
results of the trials
Dr Rakesh Jalali, medical director,
Apollo Proton Cancer Centre, Chennai