Personalised and "evidence-based" treatment rather than a generic approach is the "way forward" for cancer cure across the world, including in India, international oncology experts have said.
Cancer experts from around 15 foreign countries had gathered here for a global conference on head-neck cancer, which ended last evening. During the four-day event, they exchanged domain knowledge and discussed ways to develop a universal model for cancer management, besides sharing the new technological developments in the field.
"In India head-neck cancer is more common than in the US where lung cancer and other cancer incidences are more. During a trial at our centre, we realised the tumour mutation was different in different cases. We did a genetic profiling and the treatment was given based on mutation.
"This trial and the general feel among cancer experts now is that the model of treatment should move from generic one to personalised, precision-based one. And, it holds for across the world, including India," says Nancy Lee, Vice-Chair at the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center (MSKCC) in New York.
During the conference, organised by the International Federation of Head and Neck Oncologic Societies (IFHNOS) and Foundation for Head-Neck Oncology (FHNO), Indian experts presented research papers on two days, while foreign experts did on the rest two days.
"The event has given the impetus to start new studies to decide what is the best treatment and the way to do cancer management together. Lot of cancer cases in the US were detected at early stage, because of patient education and availability of care," Professor of Surgery at MSKCC, Ashok R Shaha said. "The key words now are personalised, evidence-based and precision, when it comes to treatment," he said.
Claudio Cernea, Professor of Surgery in the Department of Head and Neck Surgery at the University of Sao Paulo's Medical School, says, "It has to be a multi-modality treatment." "We need to reduce the aggressiveness of the treatment. The Tumour Board has a team of professionals, and it is important that we take special decision, eg in cases of thyroid cancer surgeries," he said.
Carol Bradford, Professor of Otolaryngology at the University of Michigan's Medical School believes, "While there may be epidemiological differences for India and the West, it comes almost to the same care. "And, knowledge and skill of doctors here in India is very impressive. Also, oral cancer is by far the highest in India, so there is lot to learn from here." According to experts, the annual incidence of head and neck cancers worldwide is more than 550,000 cases, while in India, out of the 11 lakh incidences a year of cancer overall, 2.5-3 lakh are of head and neck cancer.
"Individualised treatment is the new step forward for cancer, in India also. The volume of disease in India is so high. And, tumour of one patient is different from others. There are molecular differences in tumours," New York-based head and neck surgery expert, Kepal Patel said. "And, whether is is squamous cell cancer or other types of cancers, it should be targeted with more drugs instead of treating everybody aggressively," he said.
Professor of head-neck surgery and otorhinolaryngology at the AIIMS and the Organising Chairman of the conference, Alok Thakar, said, "today for every patient we do a multi- disciplinary planning. We sit together and then decide how the patient is to be treated. It is called the Tumour Board. And, it is known to improve not just survival but also the quality of survival."
Indian and foreign oncologists also agreed that in the arena of cancer treatment, it is now a "team sport" and the age of "I, me, myself" is gone. "There are radiation, medical and surgical oncologists, and it is a team work today. The days of 'I-I-I, I am the hero, I m the leader' are gone," he said.
Shaha said, "Cancer management requires a lot of thinking and not a biased opinion of one individual. We used to be biased. It was all about 'me, myself' but it is now 'me and us'." "Also, one of the goals of this event is to to have a unified treatment philosophy around the world," he added.
The New York-based doctors also praised the Indian government's decision to put disclaimer during film exhibitions in theatres, saying, "the effect would not be immediate but in next 20-25 years, it will show its impact."
Claudio said that the initiative to have a World Head and Neck Cancer Day on July 27, was taken by Indian doctors and many monuments are lit up on that in a special colour day to mark it. Talking about cancer treatment and research scenario in India, Nancy said, "In India, you have lot of tissues... So, different markers to look at. Also, I heard, India is going to get a proton beam in Mumbai, and next in Bangalore, it is so exciting." On other cancers Shaha said, "The good thing about thyroid cancer is, its outcome is excellent compared to tongue or voice box cancer."
"And, the earlier is detected, the better it is. In tongue cancer, the survival is 60-70 per cent while in thyroid case it is 98-99 per cent," he said. An international test (viva voce) for competency in head and neck cancer was also held on the last day of the conference, for young surgeons, by IFHNOS. "Previously it was held in Prague, followed by Moscow, Riyadh and now Delhi. Next it would be held in Korea an South America," Thakar said.