HEALTHBefore immunotherapy
came in, melanoma
was a death sentence
of sorts. Patients would
not survive for long.
Dr Jyoti Bajpai, medical oncologist and
professor at the Tata Memorial Hospital“The side effects are not the classical ones such
as hair loss and a drop in white blood cells. How-
ever, some immunotherapy drugs may show side
effects such as colitis and hepatitis,” he says.
For Fernandes, however, things went rather
smoothly. He did, of course, experience fatigue,
and some skin rashes, but not the more serious
side effects. “I was really lucky, because the drugs
cured my diabetes, and even my shortsighted-
ness,” he says.
The cost, however, is a big challenge in immu-
notherapy. “There are no generic drugs, so these
drugs used in the treatment are expensive,” says
Raina. “In lung cancer, the cost is a bit less, be-
cause the Indian government controls the price.
It's, in fact, cheaper than in the US. But not so
for those used in other cancers.” The cost of lung
cancer treatment would be up to 0 1 lakh, every
15 days, he says. And the treatment could last up
to six months.
In India, says Raina, the cost factor becomes
even more important because head and neck
cancers are common among the poor, for whom
this therapy is out of bounds.
For Fernandes, the cost was even higher be-
cause, in 2015, the drugs were being imported
from the US. “The treatment cost me 0 50 lakh,”
he says. “Add another 0 50 lakh for hospital stay,
tests, travel, and other personal expenses. I was
lucky that my company covered all my costs.”
Bajpai says more trials in India could help be-
cause, in Indian patients, shorter doses work, and
costs can hence be brought down. Besides the
cost, oncologists caution that the hype around
immunotherapy might not be worth it. “It's a
mixed bag. All of the checkpoint inhibitor drugs
don't work, and some drugs are actually quite
useless,” says Raina.
For all the buzz around it, only 40 per cent of
the patients will respond to this treatment, says
Jalali. “It's not a magic wand,” he says. The com-
plications can wreck havoc inside the system,
and you also need a different criteria, instead of
the standard scans, to judge whether the cancer
has gone away, he says.
“It's defi nitely not a panacea for all kinds of
cancers,” says Narula. In practice, immuno-
therapy, particularly CAR T-cell therapy, could
pose several challenges. “It is after all a living
drug inside your body, and sometimes it could
attack normal cells, too,” says Narula. The re-
engineered T-cells could release a large amount
of cytokines (chemical messengers that help to
stimulate and direct the immune response), trig-
gering high fever and a drop in blood pressure.
Besides, they could also attack the B cells that
produce antibodies. But both these side effects
are being managed.
“Still, it is not easy. Once you take out the
T-cells and re-engineer them, you also need to
keep the patient alive for those two to three
weeks when the cells are being worked on in the
laboratory,” says Narula.
The opportunity in immunotherapy is im-
mense, though, says Jalali. “We need to collabo-
rate with the global community, and be intellec-
tually honest about the results of the trials,” he
says.
Even as doctors monitor Fernandes every
three months, the ways in which his body has
responded offers hope to several cancer patients.
“Cancer is not the end, people must know that.
You need to have the courage, though, to try
something new, too,” says Fernandes. ◆THE WEEK · JULY 29, 2018 31