All about Precision Oncology

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1. How do you see the cancer landscape of India taking shape?

India is facing an epidemic of cancer. The numbers of cancer patients we see in India seem to be very high. It is estimated that around 10 lakh patients in India are diagnosed with cancer every year. Unfortunately most of them get diagnosed at a late stage.

Over the past 10 years it is understood that the numbers have literally doubled. In India we know that there are certain unique aspects with regard to the incidence and distribution of cancer. We are also seeing that they are getting diagnosed at a relatively younger age.

The incidence of cancer is from 30 to 69 year of age and this seems to be the biggest burden in our country as compared to most developed nations where these cancers are seen at a relatively older age group. We also see a very high incidence of cancer in the younger age group like the children and adolescents. In the developed country around 1-2% of cancers are in the children whereas in India it is 15%. If the patients can be diagnosed at relatively early stage there is a possibility that a large proportion of these patients can be saved.
2. How is the cancer burden in India different from others?

We understand that the cancer burden within the country itself is different in different parts of the country. This is probably related to the food, ethnicity and the lifestyle. Within the country there is a very heterogeneous distribution of the cancer burden. The per capita expenditure on individual patients seems to be higher if only you can diagnose it at an early stage and also simplify the treatment options. You need to be aware of the various special aspects of cancer in our country to find a broad solution.
3. What are the technological advancements that have taken place in the field of cancer?

As the disease burden is going up, a lot of these technological advances are beginning to be available in our country

We have very exciting developments that have happened in the surgical oncology, minimalist surgeries, robotic surgery, precision oncology. In radiation oncology, high precision radiation oncology is the new exciting thing that is happening. We are also looking forward to establish our own proton centre in the very near very future. It is probably the first in the Asian country and will also be a big advancement in the field of radiation oncology.
4. What is Precision Oncology?

Precision medicine is a personalized approach to treating cancer based on a patientâ€™s individual genetic makeup. While traditional methods treat cancer by disease type, precision medicine looks at specific cancer-associated genes in cells and then targets the "Achilles Heel" of the tumor, or the genetic drivers that cause cancer.

Therapies are matched to pinpoint and destroy specific genetic abnormalities and mutations in a patientâ€™s tumor, while sparing normal cells. Genomic sequencing, a process used to determine the genetic makeup of a patientâ€™s cancer, may reveal that medications not conventionally used for cancer can effectively treat your cancer.
5. Am I a candidate for precision medicine?
Our personalized oncology team will determine if precision medicine may be an option by reviewing your medical history, imaging scans, lab tests and treatment history. Genomic sequencing is most often recommended for adult and pediatric patients who:
- Have active cancer that has failed standard treatment
- Have a high risk of relapse or progression
- Spend 50 percent or more of the day mobile and out of bed
6. How is it different from the other treatments?
What are we missing now - limitations of cancer care
- Limited knowledge on which treatment is going to work on heterogeneous tumors
- Inaccessible tumors
- Therapy failures
- Diagnosis of early recurrence and prediction of recurrence
With precision oncology our physicians will plan therapy based on accurate diagnosis, including molecular genetics, Reduced Toxicity, Real-time monitoring during the treatment, Personalization of chemo agents and offering the best drug combinations
7. What does Precision oncology do? What is the uniqueness?

Cancer treatment is unique as no single cancer is same. There are more than 200 types of cancer. The way it affects varies from person to person. Apollo Cancer Institutes the largest cancer network in the country which has more than 300 cancer physicians who excel in not just cancer treatment but have gone a step ahead in organ specific care have devised an approach to treatment which is precision oncology.

Precision Oncology has 3 main components Precise Diagnosis, precision planning and Monitoring, Precise Treatment and the precise expertise.
8. What is Precise Diagnosis?

PRECISE DIAGNOSIS & MONITORING - Precision Oncology, unlike traditional practices, diagnosis cancer from a genetic level. This makes diagnosis far more precise and comprehensive.

Cancer has more than 20,000 known pathways and its complex driven by gene mutations. These must be identified and targeted with focused therapies rather than ad hoc generalized treatments. The precise diagnosis help our Oncologists to take appropriate decisions based on deep evidence based information to ensure effective treatment.
9. What cancers can be treated with precision medicine?
We offer genomic sequencing for most liquid and solid cancers that have not responded to treatment. Some examples include:
- Abdominal cancers like pancreatic, appendiceal and stomach cancer
- Esophageal cancer
- Head and Neck Cancer
- Leukemia
- Lung cancer not successfully resected by surgery
- Melanoma
- Metastatic breast cancer
- Metastatic colon cancer
- Metastatic prostate cancer
- Ovarian cancer
We do not treat cancers that are responding to the current therapy.
10. What are these tests/ diagnostics?
Though they are several diagnostics which the physicians will decide after thorough examination. We would definitely mention about our revolutionary tests which are termed as game changers in cancer treatment.
- Liquid Biopsy - A first in India, this revolutionary test detects cancer extremely accurately with a simple blood test. Complementing traditional biopsies in a number of patients with additional information helping physicians to plan more precise treatment.
- Tumor Tissue Analysis - Any tissue from a tumor has all the information we need to predict its ability to spread and grow. For the first time, at Apollo, we can test for all the 20,000 known cancer pathways in tumor tissue.
11. Are these tests regulated?

One of the gray areas in genetic testing is the absence of adequate regulations and framework. There is no official framework for assessing new genetic tests that become available in India, nor any formal system for approving which tests may be used in a clinical setting. "Presently there are no specific regulations pertaining to molecular/ genetic diagnostics in India."

Accreditation is one of the ways to preserve quality and safety of the process in genetic testing. "National Accreditation Board for Testing and Calibration Laboratories (NABL) has recently modified its scope for inclusion of specific guidelines related to molecular testing. Besides few major laboratories in India voluntarily follow guidelines mandated by College of American Pathologists (CAP), US, thereby ensuring services of global standards."

As with other lab based Molecular diagnostic tests, liquid biopsies requires a lab accreditation, report to be signed by a competent medical registered pathologist and processes compliant to GLP. Datar Genetics has been NABL and ISO certified, processes are compliant with Good Laboratory Practices (GLP) and they voluntarily practice the College of American Pathologist (CAP) guidelines, ensuring global standards. An internal diligence through a team of experts has visited Datar Genetics labs to validate these processes and accreditations.
13. What is precise treatment being added?
PRECISE TREATMENT - Be it chemotherapy, radiation or even surgery, at Apollo Cancer Institute, weâ€™ve made our treatment methodologies far more precise and effective. Apollo Cancer Institutes are the one and only to introduce advance treatment technologies in India in par with the western world including the latest Tomotherapy which is already available and proton therapy (which will be commissioned soon). These technologies will help our clinicians to provide personalized cancer therapy and will ensure the treatment is exact on the target reducing normal tissue scarring and minimizing side effects

Some of our expertise includes
- Chemo Sensitivity - Different patients react differently to a drug. At Apollo, we match the genome of the cancer and the patient, and we tailor-make chemotherapy. So, fewer side effects and better effective in majority of patients.
- Robotic Surgery - with minimally invasive and Robotic surgeries, excision of tumour at Apollo is extremely precise, comprehensive and risk free.
- Cyberknife and Tomotherapy - radiation, unless extremely precise, harms the healthy tissues just as easily. At Apollo, with equipment like Cyberknife, Tomotherapy and Proton (coming soon), radiation is as accurate as it can be.
- BMT- Dedicated state of the art BMT units. Our expertise include allogeneic transplant along with autologous transplants.
14. How do you see precision medicine in cancer care evolving over the next few years?

On one hand, diagnostics are getting better and better at characterizing the key drivers of individual patient tumors. Next-generation sequencing and blood-based biomarkers will allow deeper analysis of molecular targets, and will also demonstrate how a tumor evolves - especially during treatment and during development of resistance. This will allow "precision therapy", i.e. addressing the individual tumor, and even adapting treatment to changes of the tumor over time.

On the other hand, our therapeutic armamentarium will become more and more specific, and we will utilize combinations of our various tools to combat cancer. We are at the forefront of these developments, and we are shaping the landscape of Cancer treatment in oncology.
15. Precise expertise and Largest Cancer Network
Apollo Cancer Institutes are led by some of the finest oncologists in the world. And more than technology or equipment, itâ€™s they who make cancer conquerable at Apollo.
- Data and Analytics - Apollo Cancer Institutes is the largest network of dedicated cancer facilities in the country with 8 hospitals and 300 clinicians. These clinicians expertise is augmented by immense data and intelligence constantly provided by the network. As cancer manifestations vary from person to person this data helps in identifying, matching with the pathways and provide tailor made treatments to patients.
- Organ-specific tumour boards and clinicians - the expertise here is as precise as the approach. Oncologists specialise in organ spedicific, making treatment yet more precise. We have breast surgeons, head and neck oncologists, sarcoma specialists, gyneac-oncologists, hemato-oncologists etc.
- The largest network of Oncologists - There is an Apollo Cancer Institute in every corner of India. Making it a formidable force against cancer.
16. Can you suggest what treatment works for me?

Different elements of precision oncology apply to different tumors. You doctor is the best to decide the course of treatment. Ask your oncologist /doctor today for more details.

Apollo Cancer Institutes are in Chennai, Hyderabad, New Delhi, Kolkata, Ahmedabad, Bengaluru, Bilaspur, and Madurai.
17. What are organ specific tumor boards?

To plan diagnostics and therapies of oncological diseases, a coordinated multidisciplinary approach is needed to use the full potential of surgical, medical and radiation tumor therapy. The organ-specific tumor at Apollo cancer Instituteâ€™s consists of experts from all clinics involved to discuss diagnostics and therapy options for patients which are most beneficial and ensure effective treatment .
18. Will precision medicine cure my cancer?

Precision medicine is an effective alternative to standard chemotherapy for many patients, but it is not necessarily a cure. Our goal is to select the most appropriate therapy for your individual cancer so that you can enjoy improved health and a longer, better life.
19. How can I get a second opinion/ consult with tumor board?

Apollo cancer Institutes is the largest network of Cancer Care in the country. The clinician network for cancer care focus of data driven treatment options. Second opinions can give you more insights in your treatment option. Now you can request for a second opinion / board consult on line by simply logging on to www.askapollo.com

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