Targeted Therapy for Cancer In India

An increasing number of individuals are turning to targeted therapy as a preferred treatment option for cancer in India due to its remarkable effectiveness compared to traditional chemotherapy. While chemotherapy typically achieves success in around 30% of cases, targeted therapy boasts success rates of up to 80%. Unlike chemotherapy’s broad approach, targeted therapy operates more precisely, akin to a sniper, precisely targeting cancer cells without harming healthy ones.

However, not all cancer patients are suitable candidates for targeted therapy. Its effectiveness hinges on accurate diagnosis and tailored treatment plans crafted by skilled medical professionals. Each patient’s symptoms are unique, necessitating personalized care. This approach, often termed “Precision Medicine,” ensures treatments are finely tuned to the individual, resulting in enhanced efficacy and a greater likelihood of successful outcomes.

Let’s understand more about this in detail.  

What Is Targeted Therapy in Cancer Treatment?

Targeted therapy is a modern cancer treatment that targets cancer cells directly while sparing the majority of healthy cells.

 How it works:

Cancer cells contain genetic changes (mutations), which cause them to grow and spread abnormally. Scientists discovered that certain proteins and enzymes function as messengers, fueling this growth. Targeted therapy drugs inhibit these signals, or cause cancer cells to self-destruct, without harming most normal cells.

 Why it matters: 

Compared to chemotherapy, which affects all rapidly dividing cells, targeted therapy is more precise and often has fewer side effects, such as nausea, hair loss, or fatigue.

 Limitations: 

Targeted therapy does not provide a universal solution. Not all cancer types have the same mutations, and treatment effectiveness is determined by the tumor’s genetic profile. For the best results, it is usually combined with other treatments such as surgery, chemotherapy, radiation, or immunotherapy.

Future Prospects: 

Researchers are constantly developing new targeted drugs, making this approach one of the most promising advancements in cancer treatment.

Benefits of Targeted Therapy

Targeted therapy offers several benefits as a treatment for cancer:

Precision Targeting: Unlike traditional treatments like chemotherapy, targeted therapy precisely identifies and attacks cancer cells while sparing healthy cells. This focused approach reduces side effects and enhances treatment effectiveness.

Higher Success Rates: Targeted therapy has shown higher success rates compared to conventional chemotherapy in many cases, offering improved outcomes and increased chances of remission.

Customized Treatment Plans: Targeted therapy allows for personalized treatment plans tailored to each patient’s specific cancer type, genetic makeup, and medical history. This individualized approach optimizes treatment effectiveness and patient response.

Reduced Side Effects: By selectively targeting cancer cells, targeted therapy minimizes damage to healthy tissues, leading to fewer and less severe side effects compared to traditional chemotherapy.

Combination Therapy Potential: Targeted therapy can be combined with other treatments such as chemotherapy, radiation therapy, or immunotherapy to create synergistic effects and enhance overall treatment outcomes.

Improved Quality of Life: With fewer side effects and a more targeted approach, targeted therapy can help improve patients’ quality of life during and after treatment, allowing them to better tolerate and manage their cancer care journey.

Potential for Long-Term Management: Targeted therapy may offer options for long-term management of certain types of cancer, helping to control disease progression and improve survival rates over time.

Overall, targeted therapy represents a significant advancement in cancer treatment, offering improved efficacy, reduced side effects, and enhanced quality of life for many patients.

Targeted Therapy Types

Targeted therapy encompasses various approaches to treating cancer by specifically targeting the abnormal processes that drive cancer growth and survival. Here are several types of targeted therapies along with examples of how they function in cancer treatment:

Angiogenesis inhibitors: These drugs hinder the formation of new blood vessels that supply nutrients to cancer cells, effectively starving the tumor. 

Monoclonal antibodies: These specialized molecules can either deliver drugs directly to cancer cells or stimulate the immune system to attack cancer cells more effectively. Examples include alemtuzumab for certain types of chronic leukemias, trastuzumab for specific breast cancers, and cetuximab for colorectal, lung, and head and neck cancers. It’s important to note that while some monoclonal antibodies directly target cancer cells, others function as immunotherapy, bolstering the immune response against cancer.

Proteasome inhibitors: These medications disrupt essential cellular functions, leading to the death of cancer cells. Bortezomib, for example, is used to treat multiple myeloma by interfering with protein degradation processes within cancer cells.

Signal transduction inhibitors: These drugs interfere with the signaling pathways that regulate cell growth and division in cancer cells, essentially halting their aberrant activity. Imatinib is a notable example, utilized in treating certain types of chronic leukemias by blocking specific signaling pathways.

Each type of targeted therapy offers a distinct mechanism of action tailored to disrupt the specific vulnerabilities of cancer cells. By precisely targeting these vulnerabilities, targeted therapies can effectively inhibit cancer growth while minimizing harm to healthy tissues, offering a promising approach to cancer treatment.

How Target Therapy Works?

Targeted therapy against cancer is like precision medicine, aiming directly at the mechanisms that drive cancer growth. Unlike traditional chemotherapy, which can harm healthy cells along with cancerous ones, targeted therapy pinpoints specific proteins or processes crucial for tumor development.

Here’s how it works:

Boosting the Immune System: Cancer cells often evade detection by the immune system. Certain targeted therapies can flag these cells, making them visible to the immune system or enhancing its ability to recognize and attack them. It’s like giving the immune system a pair of glasses to better spot the enemy.

Halting Uncontrolled Growth: Normally, cells divide in a controlled manner in response to signals. But cancer cells can ignore these signals, multiplying uncontrollably. Targeted therapies intervene by blocking the signals that drive this unchecked growth, essentially putting a brake on the tumor’s expansion.

Blocking Blood Vessel Formation: Tumors need a blood supply to grow beyond a certain size. Angiogenesis inhibitors, a type of targeted therapy, disrupt the signals that prompt the formation of new blood vessels. Without a blood supply, tumors struggle to grow or even shrink because they’re starved of nutrients and oxygen.

Delivering Cell-Killing Substances: Some targeted therapies use antibodies tailored to latch onto specific proteins found on cancer cells. These antibodies can be armed with toxins, chemotherapy drugs, or radiation, which are then delivered directly to the cancer cells, sparing healthy ones.

Inducing Cancer Cell Death: Cancer cells often have tricks to evade programmed cell death, or apoptosis, which eliminates damaged or unnecessary cells. Certain targeted therapies can override these defenses, prompting cancer cells to undergo apoptosis, effectively killing them off.

Cutting Off Hormone Supply: Hormones like estrogen and testosterone can fuel the growth of certain cancers, such as breast and prostate cancers. Hormone therapies either reduce hormone production in the body or block hormones from interacting with cancer cells, depriving them of the fuel they need to thrive.

By targeting specific vulnerabilities in cancer cells, targeted therapy offers a more precise and potentially less toxic approach to treatment, with the aim of slowing down tumor growth or even eradicating cancer altogether.

Approved Targeted Therapy Drugs For Different Cancer Types

Targeted Therapy vs Chemotherapy: What’s the Difference in Cancer Treatment?

Because targeted therapy is more precise, it is generally less strenuous on the body. However, not all cancers respond to it; treatment is determined by the tumor’s genetic profile. Chemotherapy, while harsher, is still effective against a broader range of cancers.

Targeted Therapy in Cancer Treatment: Benefits and Limitations

Targeted therapy is a type of cancer treatment that inhibits the growth of tumors by targeting specific genes or proteins. Unlike chemotherapy, it works more precisely; however, its effectiveness depends on whether the tumor contains the appropriate molecular targets.

If those targets are missing or if cancer develops resistance, the treatment may fail or become less effective over time. Even with the best match, the outcome is not always long-lasting.

Although not the same as chemotherapy, side effects can still have an impact on quality of life. Common problems include skin rashes, changes to hair and nails, and eye irritation. Patients should discuss their treatment options with their doctors.

Despite these challenges, targeted therapy continues to be an important part of cancer treatment, often in conjunction with chemotherapy, immunotherapy, radiation, or surgery. Ongoing research aims to improve its efficacy and broaden its application to more cancer types.

How To Find Cancer Targets For Target Therapy?

To pinpoint the target for targeted cancer therapy, doctors rely on specialized tests:

Advanced Genomic Testing: This involves scrutinizing the genetic makeup of a tumor to spot specific mutations that are driving its growth and behavior. If a particular mutation is identified, doctors can match it with a targeted drug designed to tackle that mutation directly.

Pathology Tests: These tests examine samples of tissue, blood, or stool. By looking for abnormal proteins or an excess of certain proteins in cancer cells, pathologists can identify potential targets for treatment. They may also examine the chromosomes within cancer cells for abnormalities.

Genetic Testing: These tests determine whether a patient has inherited gene mutations that are associated with their cancer. Identifying these mutations can help doctors tailor treatment plans more effectively.

Side Effects of Targeted Cancer Therapies

Side effects of targeted cancer therapies can be serious and varied. Some common ones include diarrhea, liver problems such as hepatitis, and changes to the skin, hair, and nails.

Skin issues are particularly challenging for many patients undergoing targeted therapy. These occur because the therapy affects the same growth factors and blood vessels needed for healthy skin. Watch out for:

Rash Resembling Acne: This can appear on the scalp, face, neck, chest, and back. It might itch, burn, sting, or be painful, sometimes leading to infection. It typically persists throughout treatment but tends to disappear once treatment ends.

Sunburn-Like Sensation: You might feel like you have a severe sunburn even before visible changes occur in your skin.

Increased Sensitivity to Sunlight: Extreme sensitivity to sunlight can occur, necessitating extra precautions when going outdoors.

Dry Skin: Nearly everyone undergoing targeted therapy experiences dry skin, which can lead to cracking, especially on the hands and feet, making tasks like using hands or walking difficult.

Swollen, Painful Sores on Nails: Painful sores can develop on fingernails and toenails, causing discomfort and difficulty in daily activities.

Scalp Sores and Hair Issues: Sores may develop on the scalp, accompanied by hair loss or bald patches. Hair may also change color or fail to regrow after treatment.

Eye Problems: Redness, swelling, and changes in eyelid position can occur, potentially affecting the cornea, the clear layer on the front of the eye.

In addition to skin-related side effects, targeted therapies can lead to other serious side effects, some of which may be life-threatening.

Before beginning targeted therapy, use gentle, chemical-free, fragrance-free soaps and shampoos. To avoid infection, notify your doctor as soon as you notice any changes to your skin. In severe cases, the treatment may need to be adjusted. Because targeted therapy is frequently combined with chemotherapy or radiation, side effects from those treatments may also arise. Always discuss potential side effects and your treatment plan with your doctor so you know what to expect and how to deal with them.

Targeted Therapy Treatment Procedure and Monitoring

Before beginning targeted therapy, your healthcare provider will thoroughly assess whether it’s the most suitable treatment for your specific type of cancer. This typically involves conducting tests on samples of your blood or tissue obtained through biopsies. These samples are scrutinized to identify particular gene mutations or changes that indicate potential targets for the therapy.

During targeted therapy, the process varies depending on individual circumstances. Your healthcare provider will outline a treatment plan tailored to your needs, providing you with a clear understanding of what to expect. Here’s a detailed breakdown of what may occur during targeted therapy:

Administration Methods: Targeted therapy can be administered in several ways:

• Oral Medication: You may be prescribed pills that you swallow.
• Subcutaneous Injection: Some treatments are given as shots under the skin.
• Intravenous Infusion: For others, therapy is administered through an IV, typically requiring visits to your healthcare provider’s office or an outpatient treatment center.

Combination Treatments: Targeted therapy might be combined with other treatments such as chemotherapy or radiation therapy to enhance effectiveness.

Frequency of Treatment: The frequency of targeted therapy sessions can vary:

• You might receive treatment daily, weekly, multiple times a week, monthly, or less frequently, depending on your treatment plan.
• Periods of treatment interruption or breaks may be scheduled as part of the regimen.

Monitoring and Follow-Up:

• Regular visits with your healthcare provider are crucial to monitor your progress.
• Monitoring methods may include blood tests, X-rays, CT scans, and other diagnostic tests to evaluate the therapy’s effectiveness.
• Your healthcare provider will inquire about any treatment-related side effects to ensure they are managed effectively.

Overall, targeted therapy involves a personalized approach with close monitoring and adjustments as needed to optimize treatment outcomes while managing potential side effects.

Types of Cancer Treatable with Targeted Therapy

Here’s a list of cancers that can be treated with Targeted Therapy:

Blood Cancers

• Leukemia
• Multiple myeloma
• Lymphoma

Brain Cancers

• Glioblastoma
• Neuroblastoma (treated with monoclonal antibodies acting as immunotherapy)

Bone and Soft Tissue Cancers

• Certain soft tissue sarcomas

Breast Cancers

• BRCA gene mutation breast cancer
• HER2-positive breast cancer
• Hormone receptor-positive breast cancer
• Triple-negative breast cancer

Digestive System Cancers

• Colorectal (colon) cancer
• Esophageal cancer
• Gastrointestinal stromal tumor (GIST)
• Neuroendocrine tumors
• Non-Hodgkin’s lymphoma
• Pancreatic cancer
• Stomach cancer (intestinal stomach adenocarcinomas)
• Hepatocellular (liver) cancer
• Cholangiocarcinoma (gallbladder cancer)

Head and Neck Cancers

• Laryngeal cancer
• Nasal cavity and paranasal sinus cancer
• Nasopharyngeal cancer
• Oral cancer
• Oropharyngeal cancer

Lung Cancers

• Non-small cell lung cancer
• Small-cell lung cancer
• Mesothelioma

Reproductive System Cancers

• Cervical cancer
• Endometrial cancer (high risk or cancer that’s come back)
• Prostate cancer

Skin Cancers

• Melanoma
• Cutaneous squamous cell skin cancer

Thyroid Cancers

• Anaplastic thyroid cancer
• Medullary thyroid cancer
• Papillary/follicular thyroid cancer

Urinary System Cancers

• Bladder cancer
• Kidney cancer
• Prostate cancer

A Brief Into Types of Cancer Treatable with Targeted Therapy

Targeted Therapy For Breast Cancer: Around 20% to 25% of breast cancers exhibit overexpression of the human epidermal growth factor receptor 2 (HER2) protein, stimulating tumor growth. HER2-positive breast cancer offers numerous targeted therapy options specifically designed to counteract this protein’s effects.

Chronic Myeloid Leukemia (CML): Chronic myeloid leukemia is primarily driven by the BCR-ABL gene, leading to the production of the BCR-ABL protein, which transforms normal myeloid cells into cancerous ones. Targeted therapies for CML focus on inhibiting this aberrant protein.

 Colorectal Cancer: Colorectal cancer often involves overactivity of the epidermal growth factor receptor (EGFR). Targeted therapies aim to block EGFR, slowing or halting cancer progression. Additionally, treatments may target vascular endothelial growth factor (VEGF) and NTRK fusions or utilize anti-angiogenesis therapy to impede tumor growth.

Lung Cancer: Rapid advancements in lung cancer targeted therapy include EGFR inhibitors, ALK inhibitors, ROS1 fusion inhibitors, and drugs targeting various mutations like KRAS G12C and BRAF V600E. These therapies aim to disrupt specific molecular pathways driving non-small cell lung cancer (NSCLC) growth.

 Lymphoma: Targeted drugs inhibiting enzymes responsible for B-cell overproduction have shown efficacy in treating lymphomas and some B-cell leukemia, offering a tailored approach to combat these blood cancers.

Melanoma: Approximately half of melanomas feature mutations in the BRAF gene, making it a prime therapeutic target. BRAF inhibitors, along with MEK inhibitors, have been approved for melanoma treatment, often used in combination to effectively tackle tumors with BRAF mutations.

Understanding the Cost of Targeted Cancer Therapies

Targeted therapies, including immunotherapy such as CAR T, often come with substantial costs, sometimes reaching tens of thousands of dollars per month. CAR T therapy, in particular, can be close to half a million dollars. However, pricing varies based on factors like medication type, administration method, treatment duration, and healthcare facility. Generally, oral medications tend to incur higher out-of-pocket expenses compared to IV treatments administered in hospitals or clinics. 

It’s essential to thoroughly understand your insurance coverage before initiating any cancer treatment to ascertain what costs will be covered. Being informed about potential financial implications can help you plan and navigate your treatment journey effectively.

Questions to Ask Your Healthcare Team about Targeted Therapy

• What kind of targeted therapy do you suggest for my treatment, and why?
• What are the goals of this treatment?
• Will targeted therapy be the only treatment, or will there be other treatments included in my cancer treatment plan?
• Are there any clinical trials available for targeted therapy that I might be eligible for?
• How will I receive this treatment and where will it take place?
• How often will I need this treatment, and how long will it last?
• What are the potential short-term side effects of this targeted therapy, and how will they be managed?
• Who should I contact if I experience any side effects, and how soon should I reach out?
• How will this treatment impact my daily life? Will I be able to work, exercise, and carry out my usual activities?
• What are the possible long-term side effects of this targeted therapy?
• Who can I contact with questions or concerns?
• How can I reach someone during regular office hours? What about after hours?
• If I’m feeling worried or anxious about undergoing this treatment, who can I talk to?
• If I’m concerned about the cost of this treatment, who can help me manage it?
• How will we know if the targeted therapy is effective?
• Will I need any tests or scans before, during, or after receiving targeted therapy?

Final Note

Navigating targeted therapy for cancer treatment can feel overwhelming, but understanding the basics and asking the right questions can empower you to make informed decisions about your care. Remember, targeted therapy offers a tailored approach, aiming to attack cancer cells while sparing healthy ones, potentially leading to fewer side effects and improved outcomes. However, it’s crucial to discuss with your healthcare team the specifics of your treatment plan, including potential side effects, frequency of treatment, and monitoring protocols. Additionally, consider exploring available resources for financial assistance and clinical trials that may offer alternative treatment options. By advocating for yourself and staying informed, you can embark on your cancer treatment journey with confidence and hope for a brighter future.