New treatment technologies and cancer! Exciting times ahead

Indian Healthcare Story is now a vividly sound business tale attracting investors from far and wide with a keen eye for growth and returns. While challenges exist, the sheer size, dynamism, and evolving landscape of medical technology, capital and medical talent offer lucrative possibilities across various segments that’s why mergers, buyouts, and partnerships are the order of the day now.

What is fuelling the industry are a host of factors ranging from demographics, rising living standards, demand for quality healthcare, and medical tourism, India now attracts patients from more than 100 countries, insurance penetration post pandemic health attitudes, and the GOI's initiative of Ayushman Bharat. But what is even more exciting is the fact that India now doesn’t lag in the adoption of newer technologies be it diagnostic, treatment or monitoring technologies. Recently, I spoke on the fast-changing landscape of emerging medical technologies in the field of cancer care: a complex and formidable speciality which is now becoming new cardiology for all corporate hospitals to drive substantial revenue and financial margins.

While chronic diseases cast a long shadow in India, cancer affects 17.2 million people and claims 8.7 million lives (50%) annually globally. India presents grim statistics of 1.7 million new cases annually (much underreported) and 50% dying within the year of detection. But there's not a glimmer but an abundance of hope with newer therapies such as Gene therapy, genomics, precision medicine, newer machines, modalities, and types of radiation particles emerging as powerful tools, offering personalized approaches and renewed hope for better disease outcomes. Let me sketch a brief picture with all of them and their availability -

Gene Therapy: - Gene therapy works at the core of the problem by correcting genetic mutations in 10-15% of cancers linked to them. It's showing huge promise, with India's first CAR-T cell therapy for blood cancers already approved, Apollo has launched it 3 days back only, and 30+ clinical trials exploring its application in various solid tumours. CRISPER; a molecular scissor is already approved for Sickle Cell anaemia, However, challenges like limited regulatory approvals, and high cost will remain for some time. Despite this, the oncology fraternity remains optimistic, advocating for wider access and affordability.

Genomics: Genomics, with its ability to map a patient's complete genetic makeup, is revolutionizing cancer care. Liquid biopsies, minimally invasive tests detecting circulating tumour DNA, are enabling earlier detection (potentially saving 20-30% of lives) and improved risk prediction thereby making us capable of detecting high-risk populations. Additionally, next-generation sequencing helps identify specific mutations in 80% of cancers, paving the way for more targeted therapies. Understanding genetic predisposition can enable us to frame better preventive measures that can be implemented, potentially reducing cancer incidence by up to 30%. I am not including the preventive measures of lifestyle, environmental and other carcinogens.

Precision Medicine: ?Gone are the days of cumbersome chemo clinics, the new buzzword is Precision medicine therapy which represents the culmination of these advancements, with the potential to increase treatment response rates by 30-50%. Immunotherapies, harnessing the body's immune system to fight cancer, and genomic testing together are the key weapons in this arsenal. While immunotherapy shows promise for specific cancers and genomic testing has already laid the way for personalized treatment selection, however challenges like cost and monopolies on immuno-drugs have been a deterrent to achieving scales and benefit a larger patient population. But soon medical oncology will be out of bigger hospitals. Bigger corporate hospitals like Max, Fortis and Apollo have successful business and service models around precision clinics.

?Radiation Oncology: - Once scaring gantries in the basements are now a most exciting field of cancer management that is experiencing a metamorphosis of sorts with cutting-edge technologies right from Photon, Proton, and now carbon Ion fused with CT, MRI and PET offering unimaginable precision, accuracy, and control on cancers, orchestrating a symphony of progress with fair share of challenges. Let me paint a sketch of all these.

Photon Therapy: - The mainstay of radiation is now geared with highly precise modalities such as SBRT, IMRT, IGRT, SRS, SRT, and VMAT to name a few which make treating every tumour possible with accurate dosage needed without any compromises even in moving organs. What makes it even more exciting is newer machines like ZAP-X which is exclusively a neuro-radiosurgery established at Delhi Apollo and Cyberknife-7th capable of treating even bigger tumours with more precision. Newer machines are now fused with high-imaging MRI and CT. Yashoda Hospital chain just up the country's first MR-linac and Fortis is going to be the 2nd one to have MR-Linac in Delhi NCR. Delhi already has TOMO a precise machine for large spinal and complex tumours. The toxicity and dose spillage around tumours is now history.

Proton Therapy: - Another tech marvel which is now available in India with both Tata Memorial Cancer Hospital, Mumbai and Apollo Proton Cancer Centre, Chennai. Proton is a particle therapy widely accepted to have very high precision, minimal side effects and greater control and range of energy needed to treat difficult-to-treat cancers like chordomas, sarcomas, paediatric tumours, breast malignancies etc. It was a domain of the advanced countries now available in India and well-approved by all The TPAs and Insurance. Doctors can sculpt the tumour with a pencil beam which makes it a choice of radiation therapy with emerging therapies. India now boasts of 2 Protons not imaginable to have this technology in LMICs. Re-irradiation is now possible even for recurrent cancers. Proton is now one of the most exciting and spreading radiation technology with over 135 installations across the world. Single gantry protons are now reducing the cost to an affordable level to extend benefits to the masses.

Carbon Ion Therapy: - Another exiting agent is Carbon ion therapy (CIT) with unique physical properties, drilling its dose precisely within the tumour. This offers exciting opportunities for radiation oncologists to tame radioresistant tumours like glioblastoma and head and neck tumours. It's available only in 5 countries as of now with its challenges of high CAPEX and operating cost, limited technical availability, and research evidence for long-term effects. Carbon iron therapy is hugely promising and only waiting to have enough clinical evidence to become mainstream. As technology improves its cost will come down with adoption.

Flash Radiotherapy: Imagine radiation is a single sitting (fraction) instead of 30 sessions/ Fractions over a period of 2 months. That’s how Flash technology promises to revolutionise radiation therapy. Offering another hope for a faster and sure fight against the disease. This superfast therapy targets tumours with laser-like precision, potentially for resistant tumours and requiring high doses. Along with Flash therapy, already Hypo-therapy is fast becoming commonplace for many tumours.

Robotics and other therapies; - India now boasts of more than 100 installations of surgical robotic installations and around 2000 surgeries or maybe more. The surgical skills and technologies are now becoming mainstream for most cancer surgeries be it Gastro, Rectum, head & neck, or thoracic cancers. Cancer surgeries are now driven by precision with probes.

In conclusion, - Before I conclude I must share that I have yet not talked about radiopharmaceuticals another exciting field, and radiomics with the power of AI which holds huge potential for both reading images and running detecting algorithms for identifying cancers. The technological landscape of oncology is brimming with huge potential which is getting realised as we talk about it. We are witnessing a progress of decades into a year as the technology produces more technology. A reason why every hospital big or small is keen on establishing cancer care. Yet, a litany of challenges remains like a multi-disciplinary approach, unknotted clinical functioning, and patient-focused services. And lastly the cost of treatment for cancer. These times are exciting in cancer care with the future holding out lots of promise for this hitherto complex medical monstrous demon.