Today Immunotherapy can cure even fourth stage cancer: Dr Dattatreyudu Nori
In the last two and a half or two decades ago, we have unravelled the mystery of cancer cell on how it forms, how it metastasises and what are its characteristics, we came to know very precisely in the molecular biology spectrum.
Globally, the number of cancer cases are close to 19 million. In India, there are around 1.3 or 1.5 new cancer cases every year. The types of cancers vary from country to country. In the US, lung cancer is the number one among men and in females, breast cancer is the number one. As far as India is concerned, the top 2 or 3 cancers in females are cervix, breast and oral cavity. There are some recent reports saying that the cases of cervix cancer may have dropped by 2 to 3% but those numbers have to be verified. I still consider cervix cancer as the number one killer in India and the next one is breast cancer.
Latest Advances in Oncology
The latest advances in oncology are immunotherapy. I will give a few points on how did we come to immunotherapy. A few decades ago, our understanding of cancer cell on how it develops, how it metastases in the body and how it gets its own blood supply was very little. In the last two and a half or two decades ago, we have unravelled the mystery of cancer cell on how it forms, how it metastasises and what are its characteristics, we came to know very precisely in the molecular biology spectrum.
For example, cancer is in the central DNA of the normal cell, there is a cell membrane and a central nucleus, we thought the nucleus is getting highly proliferating and producing a DNA typo, which is a programming error that is resulting in cancer. The normal cell is becoming cancerous and that was a misunderstanding we had for many decades.
Now we understood, in recent times that it is not the central area, the signal to multiply is coming from the cell membrane. While some enters from outside the membrane, from the membrane and also from inside the membrane, there are signals going to the DNA to multiply and this understanding has resulted in the discovery of drugs to block signal for controlling cancer in the centre or eliminating it completely. These are called designer drugs or targeting drugs precision medicine, so each drug we discovered has blocked the signal and has cured that particular cancer.
For example, chronic myelogenous leukemia can be cured by Gleevec, which is a signal-blocking drug. Another one is Tarceva, which is helpful in lung cancer and I have seen lung cancer patients with this simple drug oral pill surviving 8 to 10 years without any symptoms.
Each designer drug was controlling, curing and helping one particular cancer, that was the era of precision medicine. We thought this was good, but not good enough. What is the next step? What can we do to get something that works across all the signals around this cell membrane and that is immunotherapy, which works on all signals at simultaneously, so, we have a chance for eliminating, controlling and curing cancer, even if it is a fourth stage cancer. This is the beauty and the advantage of immunotherapy because like chemotherapy or radiation is not killing the cancer cells but is stimulating our body‘s immune system. This is the major difference between chemotherapy, radiation and immunotherapy.
During the development of cancer cells, it produces two nasty substances one is called PDL 1 and the other is called CTLA and these two substances produce a molecular shield on our body immune system so that our own system won’t be helpful anymore. We found drugs for these two nasty substances that can eliminate them or also known as break releasing drugs, the break is put by the cancer cells. These drugs are also called molecular shield penetrating drugs or immune modulation drugs and they have completely changed the outcome of cancer treatment, the new paradigm in cancer treatment because it is the stimulation of immunity in the body is controlling and eliminating the cancer cells.
One case example is Jimmy Carter, one of the ex-presidents of USA. He developed melanoma that is cancerous to the brain, liver, lung, bone and in the golden days there was not much we can offer to him but we gave him immunotherapy where the immune system is stimulated with these drugs. The brain tumour, brain lesion has disappeared. He is free of cancer and it’s been around seven years. These kinds of miraculous responses we have not seen before, which is good news for all our patients too.