India Today - - FROM THE EDITOR-IN-CHIEF - (Aroon Purie)

inod Khanna was a huge star for my gen­er­a­tion. He was also a friend. When can­cer claimed him last month, it was yet another case of the dis­ease’s seem­ingly re­lent­less march. World­wide, can­cer is on the way to equalling car­diac dis­ease as the big­gest killer. In In­dia, it is now the sec­ond big­gest killer, af­ter heart dis­ease and stroke, up from sev­enth po­si­tion in 2000, re­ports the World Health Or­ga­ni­za­tion. While can­cer deaths are fall­ing in the West, they are ris­ing here, with 70 per cent lives snuffed out in the first year af­ter dig­no­sis, as 80 per cent pa­tients con­sult doc­tors at a stage when re­cov­ery is im­pos­si­ble.

Yet, there is hope. Ad­vances in molec­u­lar bi­ol­ogy, next­gen­er­a­tion gene se­quenc­ing, big data and in­no­va­tive di­ag­nos­tics are open­ing up a whole new world of pos­si­ble cures. A new gen­er­a­tion of life­sav­ing and life­ex­tend­ing ‘smart drugs’ is cur­rently be­ing de­vel­oped and tested, while In­dia’s first vac­cine for cer­vi­cal can­cer pa­tients un­der Phase 2 clin­i­cal tri­als is a fine ex­am­ple of Make in In­dia suc­cess. With the in­ci­dence of cer­vi­cal can­cer ris­ing dra­mat­i­cally among In­dian women—nearly 23 per cent of all can­cers in women and over one lakh deaths a year—it might just be a game­changer. One of the pa­tients in­cluded in Phase I of the clin­i­cal trial at the Can­cer In­sti­tute in Delhi, whose cer­vi­cal can­cer had spread to the lungs even af­ter ra­dio­ther­apy, has been dis­ease­free now for over nine years.

Ma­jor in­sti­tu­tions across the coun­try are work­ing on ba­sic, trans­la­tional and clin­i­cal re­search. New and po­ten­tially ther­a­peu­tic mol­e­cules have been iden­ti­fied at the In­dian In­sti­tute of Sci­ence, Ban­ga­lore, there is a multi­cen­tre study un­der way at the Na­tional In­sti­tute of Bio­med­i­cal Ge­nomics at Kalyani, West Ben­gal, and Tata Me­mo­rial Cen­tre’s Ad­vanced Cen­tre for Treat­ment, Re­search and Ed­u­ca­tion in Can­cer in Mumbai. At hos­pi­tals and lab­o­ra­to­ries across the coun­try, in­no­va­tive molec­u­lar ge­netic tests, tech­nol­ogy and tech­niques are be­ing used. In­dia’s first com­mer­cial bio­bank and per­son­alised medicine com­pany is grow­ing live can­cer cells in Hy­der­abad to un­der­stand the com­plex­ity of a tu­mour, screen new drug can­di­dates, use cul­tured can­cer cells as mod­els to in­ves­ti­gate the changes that may have caused can­cer, or its spread, or its re­sis­tance to a ther­apy.

Liv­ing with can­cer is emerg­ing as a pos­si­ble op­tion, where the con­ven­tional reg­i­men of surgery­ra­dio­ther­apy­chemo­ther­apy is slowly but surely giv­ing way to tar­geted, per­son­alised treat­ments and more in­tri­cate di­ag­nos­tic tools. The emerg­ing field of can­cer im­munother­apy, or us­ing the body’s own im­mune sys­tem to com­bat the dis­ease, is es­pe­cially promis­ing. A par­a­digm shift is tak­ing place, with the ap­proach mov­ing to­ward a reg­i­men where can­cer may not have to be cured, but con­trolled, like di­a­betes or heart dis­ease. A whole range of new drugs to­day can shrink and kill can­cer cells with­out col­lat­eral dam­age while the new ac­cu­racy of ra­di­a­tion tech­nol­ogy makes it pos­si­ble to hit tu­mours with min­i­mal dam­age to sur­round­ing nor­mal cells.

There is no cure yet but the three brute force treat­ments—surgery, ra­di­a­tion and chemo­ther­apy—may well give way to so­phis­ti­cated meth­ods of con­tain­ment. Our cover story is writ­ten by Ex­ec­u­tive Ed­i­tor Da­mayanti Datta, who has tracked the dis­ease since 2007 and done five sto­ries on the sub­ject, two of which have al­ready been on cover. She says this time she was de­pressed by the data she found on the rise of the dis­ease but also ex­hil­a­rated by the prom­ise in break­throughs: that sci­en­tists are prim­ing the body to heal its own can­cer, that they can now lis­ten in to the ‘lan­guage’ of genes and that can­cer could one day be­come just another dis­ease that can be de­tected, man­aged and con­trolled for many, many years just by pop­ping a pill—say, like di­a­betes.

This is re­ally good news as there is hardly any­one these days who does not know some­one who is not suf­fer­ing from the Big C. It has been the most dreaded dis­ease of mod­ern times and for med­i­cal sci­ence to tri­umph over it will be a huge achieve­ment for hu­man­ity.

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