Dr Bharat Patodiya
How Cancer care has changed in the past 10 years
Updated: Jun 24, 2019
Cancer treatment has seen many paradigm change in the last 10 years. From the point where we used to offer maximal tolerable doses to now when more and more studies are favoring de-escalation of duration as well as dose.
For example for a low risk colon cancer now we are offering only three to four months of chemotherapy, while previously six months of perioperative chemotherapy was compulsory. This de-escalation treatment has not only reduced toxicity but also leaves us with a possible chance of utilizing the same chemotherapy again if the cancer relapses.
Even breast cancer has seen de-escalation. Now in a stage 2 hormone positive cancer we primarily offer genomic expression profiling. If the genomic expression profiling comes to be of low risk we do not offer chemotherapy in such cases. Another type of breast cancer which is known as HER-2 positive disease there are upcoming research data that six months of anti HER-2 therapy could be non inferior to your present one year of therapy.
Moreover for advanced diseases the advent of immunotherapy is a paradigm shift. Immunotherapy is making its way into almost all types of cancers. This is a new mode of treatment available to us since around 3 years. The main difference between immunotherapy and chemotherapy is that chemotherapy kills the cancer cells directly while the immunotherapy increases the immunity to kill the cancer cell. For this reason the classical side effects of chemotherapy do not happen in immunotherapy. Though immunotherapy has its limitations and set of complications also, still it is well tolerable in most cases even in elderly.
Immunotherapy was initially launched for metastatic disease, however it is now also being used in stage 3 lung cancer after finishing chemoradiation.
Scientists are now combining chemotherapy with immunotherapy as well as other targeted therapies and are finding more promising results than either of the arms alone.
These advancements are truly paradigm changing, and help us to control the disease for longer duration of time and can increase the life span of the patient.
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