Understanding Precision Medicine for Cancer.

We often hear of Precision Medicine for Cancer, but what is Precision Medicine, how is it different from standard treatment protocols and what can be the benefits for choosing Precision Medication over standard protocols?

The diagnosis and treatment of cancer at a cellular or molecular level is known as Precision Medicine.

Cancer
Precision medicine : Tailored medication for cancer based on specific patients, genetic profile .

Cancer is a heterogenous disease, with different genetic profile not only between patients with different cancers but also differences in genetic , molecular and cellular profile even within the same type of cancer.

All cancers are genetic by nature and with cellular profile changing over time even in the same patient, till now no single drug is known to cure even a single type of cancer let alone different types of cancer’s.

Standard chemotherapy protocols focus of administering standard chemotherapy drugs ( one size fits all) without taking into account cellular or genetic profile of the patient.

Precision medicine on the other hand focuses on accurate and effective treatment to each patient based on the genetic profile, the proteins feeding the tumours or the cancers.

There are sufficient number of detractors even amongst the best doctors but precision medicine or administering drugs based not a specific tailored patient profile not being the best option is a pre mature conclusion.

This week being Breast Cancer week, let’s shed some light on Precision medicine for breast cancer.

Breast cancer treatment in India beyond surgical options of lumpectomy, mastectomy involves administering chemotherapy and radiotherapy, with chemotherapy being the first line of treatment.

Difference in outcomes depends upon whether the patient has been tested for HER2(human epidermal growth factor receptor 2), ER, PR or not.

For patients testing positive for HER 2, addition of trastuzumab to chemotherapy slows down disease progression. Lapatinib plus chemotherapy (i.e., capecitabine) achieved a longer median time to disease progression compared with chemotherapy alone.

A combination of pertuzumab, trastuzumab, and chemotherapy further improved the median overall survival time to a median of almost 5 years compared with a combination of only trastuzumab and chemotherapy for a median of 3 and half years.

Similarly treatment with ado-trastuzumab emtansine, a conjugate of a HER2 monoclonal antibody and a cytotoxic drug, significantly improved the length of progression-free survival and overall survival with lower adverse effects when compared with lapatinib and chemotherapy

The above examples clearly show how genetic profiling, identification of key mutations like the Bcr-Ablfusion or HER2 can benefit a large number of breast cancer patients.

Genetic profiling also enables identification of molecular targets for intervention.Cell death is caused by a combination of deficiencies in the expression of two or more genes, whereas deficiency in only one of these genes can increase viability or enhance multiplication of mutant cells. For example, BRCA (mutant gene responsible for particularly aggressive breast cancers( and poly ADP ribose polymerase (PARP) genes were found to have a synthetic lethal relationship.

For example, by using olaparib, a PARP inhibitor, to treat BRCA-mutant ovarian cancer patients, the progression-free survival of BRCA-mutant ovarian cancer patients was significantly prolonged by olaparib compared with standard chemotherapy protocols.

This methodology focusses on identifying cancer vulnerabilities and subsequent tailored treatment based on patient profile.

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Decoding CyberKnife, for cancer treatment and benign tumours

We often get queries on CyberKnife and what is CyberKnife used for ?

CyberKnife is an excellent treatment option for treating cancer’s such as prostate cancer, gliomas ,brain cancer, kidney cancer, lung cancer, spine cancer, cancer of the pancreas, head and neck cancer, liver cancer, early stage -localised breast cancer and several types of malignant tumours, benign tumours and several other medical conditions.
CyberKnife delivers stereostatic radiation( SBRT) with extreme precision and a tissue margin of 1-5mm

Non invasive, CybeKnife vaporises a brain tumour

Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated.
CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.

Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.

Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.

CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.

CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.

To know more on CyberKnife and how it works, click here.

Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.

The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on  use of CyberKnife as treatment option can be arrived.
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Breast Cancer Awareness

Breast Cancer Awareness

Breast Cancer

Being Diagnosed with breast cancer, can be an overwhelming experience especially when one has been healthy throughout
without any symptoms at all.

What are the treatment options when the mamogram says “Cancer”.

Although cancer is not a disease which any one should have, it is possible to offer curative treatment at early stages and
palliative treatment for late stage cancers.

Breast Cancer Treatment Options:

The treatment options for breast cancer, totally depend upon the stage of cancer at the time of diagnosis.

For early stage cancers, when the cancer has not really spread to other parts of the body, surgery is a good option.

For early stage breast cancer, we have surgical options such as lumpectomy, mastectomy with and without reconstruction.

For late stage cancers, chemotherapy to reduce the size of the tumour and control the disease is the first line of
treatment, followed by radiation and hormone therapy.

The long term survival rate of someone diagnosed with breast cancer is based on the spread of the disease. Such
characteristics will include the size of the tumor, whether there are hormonal receptors found on the tumor itself and the
tumor grades.

Breast Cancer Treatment Cost:

Cost of breast cancer treatment in India varies depending on whether surgery is required or not.

Surgery costs vary between us 4500-6000. Chemotherapy costs usd 1000 onwards depending upon drugs administered. Radiotherapy costs us 3500 onwards for a 6 week duration.

Breast cancer treatment cost in India is a variable of whether just one or a combination of treatment options which may be
required based on stage, grade of cancer at the time of diagnosis.

Factors such as age may also play an important part on which treatment a patient should undergo.

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To know more on the signs and symptoms of breast cancer,

Read More.

Breast Cancer Treatment, Procedures, Cost in India

Breast Cancer Treatment, Procedures, Cost in India

Breast Cancer Treatment

When diagnosed with breast cancer, this can be an overwhelming experience. Treatment options depend upon the stage of cancer.

For early stages we have lumpectomy, mastectomy with and without reconstruction along with chemotherapy, hormone therapy and radiation. . There may be a great concern of which surgical options are best to treat the type of cancer diagnosed.

The long term survival rate of someone diagnosed with breast cancer is based on the spread of the disease. Such characteristics will include the size of the tumor, whether there are hormonal receptors found on the tumor itself and the different types of tumor grades.

 

Factors such as age may also play an important part on which treatment a patient should undergo.

For example, patients over seventy years old may not usually undertake the more aggressive treatments.

Chemotherapy is a common treatment used by many patients to prolong their life expectancy and survival rate, which is usually done before or after surgery depending upon stage and spread. Many patients will have to avail a combination of treatment options.

Types of Surgical Procedures:

Lumpectomy is a surgical procedure where a part of the breast is removed. The medical term of lumpectomy is called partial lumpectomy. This procedure may or may not be accompanied by radiation therapy. When radiation therapy is used, this will help to kill the cancer cells surrounding the lump.

Mastectomy is a procedure that removes all of the soft tissue from a woman’s breast. This type of procedure can impact a woman’s emotional state higher than if she underwent a lumpectomy procedure as the patient is left with a flat chest. Patients who inherit abnormal genes or have a family history with a high occurrence cancer rate will be better off undergoing this type of surgery.

Breast Reconstruction is done to try to restore the normal appearance of a woman’s breast after undergoing a lumpectomy or mastectomy procedure.

There are two types of reconstruction procedures. Both procedures involve a number of pros and cons.

A reconstruction implant is a procedure where a doctor implants a foreign object in a patient’s breast. This type of surgery has a shorter recovery time than when using your own soft tissue to reconstruct your breast. The downside is that the implant used is a foreign object and is not part of your own tissue.

Also, there is risk of infection and bacteria and possible leakage. The implant placed can build up to form a bundle of scar tissue, which can become thick and harden which will eventually change the shape of the women’s breast.
Reconstruction done from your own tissue also has its benefits and side effects. When using your own soft tissue, there is less concern about leakage as no foreign object has been implanted. There is less chance of infection and your body will not form much scar tissue around the area.

The downside is that you will have scars and open wounds which may take time to heal and the duration of the operation is much longer.

India is a country which offers great medical care by highly trained physicians as well as cheaper surgical rates, which will be a great benefit for the patient.

Cost of Breast Cancer in India:

  • Lumpectomy – $ 4500- $ 5000
  • Mastectomy- $ 6,000-7,000
  • Reconstruction may cost US$ 7500- 9000, depending on the type of reconstruction