by AMIT ROY
PREVENTION AS IMPORTANT AS CURE, SAYS CANCER EXPERT AND AUTHOR
WHEN oncologist and author Siddhartha Mukherjee gave a talk last week on the subject of cancer at the Francis Crick Institute in London, the chairman of the Indian pharma giant Cipla, Yusuf Hamied, asked a couple of pertinent questions:
What is the role of luck in getting cancer?
And why do children get cancer?
Turning to Eastern Eye, Dr Hamied, whose firm is always on the lookout for the latest drugs for cancer, said: “It has to be genetic.”
Mukherjee’s talk was called: Cancer’s Future Anxieties: Genes, Risks and Precision.
In India cancer is growing rapidly, but diagnosis is often late.
The speaker made two fundamental points: patients would in future be given personalised therapy depending on their particular cancer, and that, based on their risk of developing cancer, they would be prescribed treatment aimed at preventing the disease.
“You have a one-way passport to enter ‘the kingdom of cancer’ – you can never leave because you are under surveillance, treatment and retreatment all the time,” he warned.
Mukherjee is an oncologist and assistant professor at Columbia University in New York and is also known for his two award-winning books, The Emperor of All Maladies: A Biography of Cancer, and The Gene: An Intimate History, published in 2010 and 2016, respectively.
He was introduced as “somebody special” by Sir Paul Nurse, chief executive and director of the Francis Crick Institute, former president of the Royal Society and winner of the Nobel Prize in Physiology or Medicine in 2001.
“He is an unusual combination of being both a researcher, clinician and scientist with being a popular writer – he has written two extraordinary, successful books,” said Sir Paul. “Time has listed him as one of 100 most influential people. He writes in The New Yorker. He bridges the gap between understanding science and writing in a popular way.”
Mukherjee’s talk did address Dr Hamied’s question.
“What have the last 10-15 years taught us in cancer treatment?” he began. “What is the impact on us?”
Mukherjee said: “Yes, absolutely, we are beginning to understand cancer at the cellular, molecular level with an unprecedented amount of clarity which we did not have eight or 10 years ago.
“This understanding has highlighted the enormous diversity of individual cancers and one of the hopes is to take this understanding and make cancer a manageable disease, a chronic disease.
“This diversity may in turn demand precision medicine or partially individualised therapies and that very treatment is also likely to bring benefits.”
He went on: “We have learned that there is a role for directing therapies more precisely to individual cancers that reflect the enormous diversity of cancers that are genetic. Generally speaking, if we can identify cancers early and use therapies that are precise, we tend to have more success, than treating cancer late.
“Therefore, treating early and treating precisely are largely to be the themes – we would like to diagnose at a time when tumours can be detected as early as possible and to find ways to develop individual therapies.
“That would involve observation, diagnosis, treatment and retreatment.”
But he added: “That carries cultural burdens of the management of the disease that we are unprepared for.”
A woman in his clinic introduced him to the word “previvor”.
He explained: “Previvor is a survivor from a disease that you haven’t yet had.”
He found it chilling that “her brain was obsessed with the idea she would have that cancer”.
That example, said Mukherjee, opened up “a new vision of the human body under constant surveillance”.
The field was rapidly “moving from simple genetics to complex genetics. In the last 12-18 months we as a community of oncologists are moving progressively into this area of what detecting early means for individual patients.
“Even if you are cancer-free, should we make you into a ‘previvor’ before you develop any disease? Someone would decide at what point you would enter the world of surveillance.”
And as he had stressed before, there was only a one-way ticket into the “kingdom of cancer”