Our one-way ticket into ‘the kingdom of cancer’

THE BIG C: Dr Yusuf Hamied (left) meets
Siddhartha Mukherjee at the cancer talk
THE BIG C: Dr Yusuf Hamied (left) meets Siddhartha Mukherjee at the cancer talk



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”