In India, the use of immunotherapy will be governed by predictive testing : Prof Ezra Cohen, MD, Associate Director, Moores Cancer Center Professor of Medicine

Prof Cohen, explains the advances in immuno-oncology space. Says that patients might have the greatest chance to benefit with immunotherapy predictive testing

Tell us about the scientific advancements in the treatment of cancer using alternate therapies?

The field of cancer is changing dramatically with the utilisation of genetic sequencing and target evaluation. To that end, we now have several targeted agents that are effective against cancers by inhibiting the function of a specific gene. Moreover, we are learning how to most effectively combine these agents with other targeted therapy, radiotherapy, and chemotherapy. Lastly, immunotherapy represents a growing and novel method of treating cancer by activating a person’s own immune system against the disease. We have seen efficacy of immunotherapy in multiple cancers with some patients enjoying long-term benefit even in the setting of metastatic disease.

Which alternate therapies are proven to be helpful for cancer treatment?

There are several targeted therapies that have a proven benefit for cancer including monoclonal antibodies such as cetuximab. In addition, immunotherapies that reactivate a person’s immune system against their cancer have also proven effective.

You specialise in in head and neck cancer and part of the immuno-oncology trial in Head and Neck Cancer, so please throw some light on the therapy options for cancer patients including the immuno-oncology space.

In head and neck cancer, we have an approved molecular therapy, cetuximab, that targets a gene, EGFR, important to the growth of these tumors. Cetuximab has a proven benefit in patients with locally advanced as well as recurrent disease and is widely used in both settings. Immunotherapy has also been approved in head and neck cancer. Both nivolumab and pembrolizumab target an important checkpoint in the immune system called PD-1. This targeting allows T cells to activate against tumor cells. Both these agents have proven to be effective in patients whose cancer has progressed on prior chemotherapy. Currently, there are international clinical trials testing combining immunotherapy with cetuximab, chemotherapy, radiotherapy, and other immune modulating drugs.

Are these therapies available in India and to what extend?

These drugs are available in India but, especially immunotherapy, can be expensive which limits their use.

What will be the future of alternative therapy for head and neck cancer patients in India

In India, it is likely that the use of immunotherapy will be governed by predictive testing that allows us to determine which patients might have the greatest chance to benefit. For example, we can now test a patient’s tumor for a marker called PDL1 that, when expressed especially at high levels, corresponds to a much higher probability of response and benefit. In addition, it is likely that Indian patients will have access to the combinations discussed above and, in the longer term, dual targeting of molecular and immune alterations in a cancer to maximize benefit.

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