Rectifying Nutritional Neglect
Mysuru-based Central Food Technological Research Institute (CFTRI) has developed a food supplementary formulation, named Encircle, as a Ready-to-Eat or Readyto-Drink supplement, to aid in cancer therapy providing protection against cancer cells. This formulation with Food Drug Administration (FDA)/ Food Safety and Standards Authority of India (FSSAI) approved ingredients, has been optimised using genetic algorithms, in ovarian cancer cell lines, with a cut-off survival of less than 40 per cent and ensuring normal cells lines' survival of more than 60 per cent.
The team that developed the formulation noted that Encircle's mode of action is adapted from The Battle of Isandlwana of the First AngloZulu War of 1879, between the British Empire and the Zulu Kingdom, and focuses on four specific targets converging on decreasing GSH/GSSG ratio. The reduced glutathione/oxidised glutathione ratio (GSH/GSSG) is widely used in clinics for the evaluation of oxidative stress status in biological systems.
This, the team believes, is the first time that a food supplement has been designed, inspired by a real military strategy, to assist in combating cancer cells. The CFTRI has developed over 300 products and processes including equipment designs. Most of these technologies have been released to over 4000 licensees for commercial exploitation and the Institute is now keen to commercialise this patented formulation to interested parties.
Currently the market has both local and multinationals offering a range of onco nutrition products or supplements. Besides the leading names of the industry such as Abbott, Nestle SA, Fresenius Kabi AG, we have now Mumbai-based Esperer Onco Nutrition offering Es- Fortitude (nourish, protect & recovery) (21 gm x 14 Sachets) and Es- Invigour (base formula) (33 gm x 14 Sachets) directed towards cancer treatment, which are backed by extensive research on nutritional deficiencies in cancer patients in India. Launched in 2019, these two supplements are not available over the counter but only with an oncologist's prescription. But these products are available on e-pharmacy platforms like 1mg, Apollo Pharmacy at the price of over Rs 2000. Abbott's ProSure Powder is available at over Rs 1000 (400 gm).
The market will see the entry of many other players in the coming months as we see a growing incidence of cancer among the Indian population. According to the National Cancer Registry Programme Report 2020, released in August 2020, by the Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics & Research (NCDIR), Bengaluru, estimates that in 2020 cancer cases in India will be at 13.9 lakh and likely to increase to 15.7 lakhs by 2025, based on current trends. These estimates are based on information related to cancer collected from 28 Population Based Cancer Registries (PBCRs). Additionally, 58 Hospital Based Cancer Registries (HBCRs) provided cancer data. In 2020, tobacco related cancers are estimated to contribute 3.7 lakh (27.1 per cent) of the total cancer burden.
According to several studies, medical oncologists and other healthcare professionals treating patients with cancer seem to neglect nutritional issues, both considering screening and information or intervention. This has led the European Cancer Patient Coalition to publish a Cancer Patient's Nutritional Bill of Rights which was presented in the European Parliament in Brussels in November 2017. The Bill of Rights is also based on the updated European Society of Parenteral and Enteral Nutrition guidelines on nutrition in patients with cancer. In light of existing guidelines and patients' expectations, clearly, practising oncologists will have to do better than in the past.
Nutrition in patients with cancer is a complex issue that requires a multidisciplinary approach by involving oncologists, nutrition specialists, psychologists, nurses and other allied healthcare professionals. Medical oncologists primarily need to be aware of the complexity of nutritional questions and require better training on nutrition as a supportive care issue. With the rise in the incidence of cancer in the country, India should adopt the approach taken up by Europeans for the benefit of cancer patients.