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Metronomy is the next generation targeted therapy: Dr Shripad D. Banavali on ETHEALTHWORLD.COM

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Following the Metronomic@Mumbai meeting, Pr Banavali has been interviewed by ETWorld Heatlh.com. you can asses the interview here

Dr Shripad D. Banavali, Prof. and Head, Dept. of Medical & Pediatric Oncology, Tata Memorial Hospital, Mumbai, talks to ETHealthworld about the growing burden of cancer and changes that need to be made in order to make cancer treatment affordable and accessible to all.

What are the latest therapies in treating cancer?

We have been treating cancer with chemotherapy or systemic agent for a long time now. In this we take a drug and give higher doses of drug till we see toxicity which is also called the maximum tolerated dose by the body. At that dose, we start doing clinical trials and give it to the patients and see the efficacy. However this may not be the best way to treat patients because toxicity does not correlate with the efficacy at times.

Now there is a new method that we have started using for patients with advanced cancers called the metronomic therapy. These are therapies where we give a drug at regular intervals. It is done continuously over a period of time and sometimes even for years in certain situations.

What are the different aspects of cancer that you see in India?

At Tata Memorial Hospital, 70% or 65% of patients that we see are from the general category who cannot afford the latest and expensive therapies. Our hospital is now associated with BKL Walawalkar Hospital which is a rural hospital in the interior of Maharashtra and Tata took it up as its rural outreach programme nearly 20 years back. When we started going to this centre, we noticed that cost was not the only issue, many of these patients were in such poor nutritional condition that when we started giving them the standard of care or standard therapies many of the patients couldn’t tolerate and the side effects were compounded.

We not only had to take care of the financial issues but also the issues of nutrition and see that we give them therapies in such a way that they not only afford it but also tolerate it and that is why we started exploring the metronomic therapies. Another aspect of cancer in India is that many of the patients diagnosed with cancer come in at advanced stage. Now when the disease is advanced or spread its outcomes decreases meaning the cure rate of these cancers go down. So in many of the patients, even if you give them standard therapies, the disease comes back and in India, if the disease comes back most of the patient will not further take therapy and they will stop treatment.

Our aim was not to only treat the patients but also to make sure that the disease does not come back. With our metronomy therapies it will be an ideal way to not only use it in palliation or the palliative setting but we also started making sure that if we give this patient the standard therapy then if you continue them on maintenance with this metronomic therapies the chance of the disease coming back will be decreased.

By this we will ultimately able to improve the survival or the cure rate of this patient and this is the concept with which we started working on metronomy therapies. In Tata hospital, now we are bringing this concept and doing clinical and scientific studies wherein we are comparing metronomic therapies with the so called standard of care and trying to see if this really helps to improve the cure rate or outcomes in the patient with cancer.

Tell us about the ongoing studies in oncology.

At present we have nearly 7-8 studies ongoing where we are doing prospective trails of using metronomy therapies in different settings and the most important one’s are where we are using it is in the head and neck cancers because in India, head and neck cancer is the number one cancer.

What are the measures that need to be taken in order to bring down the cancer burden.

We need to create the awareness and ask the government or NGO’s like Wellcome Trust or Tata Trust who can help in doing studies because you require money to do any study and we will not get it from the drug companies.

We should create this awareness because we talk about made in India and metronomy therapy would be a prime example of what we can do in India for the patient with cancer. This will help in so many other low and middle income countries where there are thousands of patients with cancer and it has been projected that by 2050 about 70% of the world’s cancer would be in the low and middle income countries and unless we do something about it now, this condition will be out of hand. Most of the patients will not be able to afford the type of therapies which are being propagated and being conducted at present. The most important challenge in oncology is not just to find cure but to find affordable treatment.

How do you see the future of Metronomics in Oncology?

Metronomics is the future of oncology especially because up till now we were concentrating more only on the cancer cell. Unless we change the micro-environment of the tumour and modulate the body’s immunity, we will not be able to cure cancer. In MTD based therapies we just look at killing the cancer cell but when we kill cancer cells there are many other changes that can occur which are harmful for the body. So what we have to do is combine this MTD based therapy along with metronomic therapy and at that time we will be able to cure more cancer. Metronomy is the next generation targeted therapy and that is the future of oncology.

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