CANCER

• Cervical cancer drug majors vie for India pie
  
  Global cervical cancer drugs majors Merck and Glaxo SmithKline (GSK) are battling it out in India, which is potentially the world's largest market for such drugs.
  
  US-based Merck is confident that its cervical cancer vaccine Gardasil will help it to secure a position among the country's top five drug companies in the next five years.The world's second largest drug manufacturer currently ranks 30th in domestiv sales.
  
  "We expect Gardasil to play a key role in our India growth," says Naveen Rao, head of medical affairs for Merck's Asia Pacific Region. Merck wants Gardasil as catalyst for government's plan to immunise India's young women from cervical cancer.
  
  Represented through its wholly owned subsidiary, MSD Pharmaceuticals Pvt Ltd, Merck will roll out one of its biggest clinical trial programmes involving about 20,000 girls shortly. The partner for this trial is the health ministry.
  
  This mega-trial, which is on top of the statutory clinical trials required for getting a drug or vaccine approved for sale in the country, is aimed at convincing the government on the importance of the vaccine, and also the need for a national immunisation programme.
  
  Merck is the only company other than GSK, which has developed a vaccine for cervical cancer. According to World Health Organization estimates, India registers over 130,000 new cervical cancer cases every year, with 74,000 women dying from the disease annually. According to medical experts, women are affected with the disease during their teens or early 20s. The vaccination should be given at a young age, they add.
  
  According to offical census figures of 2001, almost 35 percent of India's one-billion plus population were women below 14 years.
  
  India in super cyclotron club
  
  Rs.100-Crore Device To Play Vital Role In Treating Cancer, Tumours
  
  Kolkata: India has joined the exclusive club of nations with superconducting cyclotron capability. Recently, the director of the Variable Energy Cyclotron Centre (VECC), Bikash Sinha, announced the successful completion of the RS.100 crore project-only the fifth in the world-that had been stalled for years due to sanctions following the Pokhran nuclear tests. The four other set-ups are in America and Europe.
  
  The device accelerates charged particles clsoe to the speed of light and is vital for frontline basic and applied research in nuclear scinences. The radio isotopes and proton beams it generates can be used in critical medical applications like creating brain tumor and eye cancer. At present, there is no healthcare facility in India that offers non-invasive proton beam surgery, which pinpoints and destroys cancerous cells.
  
  The device has a 100-tonne ironcore superconducting magnet with a magnetic field of 5 tesla (about 100,000) times the Earth's magnetic field) and an 8 tonne superconducting coil that is kept cooled at -269°C.
  
  This has given the VECC the capability to develop futuristic energy storage and transport systems. It can be used to ensure unintwerrupted power supply by releasing energy stored in coils. It can also lead to transport systems that make travel lightning quick, in excess of 500 km/hr using magnetic levitation.
  
  "The successful commissioning of the superconducting cyclotron is a huge achievement for Indian science asw there's no such facility in Asia, Australia, South America or Africa. Nealy 70% of the component and systems were indigenously developed. The embargo after the 1998 nuclear blasts delayed the project by three-four years but it also led to a lot of learning," said VECC executive director Rakesh Bhandari."India now has the knowhow to create magnets required for magnetic resonance imaging devices. It will also generate radio-isotopes used in gamma cameras for tumour and cancer diagnosis. Such isotopes will be generated commercially at the medical cyclotron being built at Rajarhat."
  
  The scientists at VECC are now keen to build a fixed energy cyclotron that will emit proton beams to treat cancer.
  
  INDIAN BITTER MELON MAY HARBOUR BREAST CANCER CURE
  
  An extract from bitter melon, a vegetable common in India helps trigger a chain of events that kills breast cancer cells and prevents them from multiplying, claims an Indian-origin researcher at Saint Louis University.
  
  Ratna Ray, PhD, professor in the department of pathology at Saint Louis University and lead researcher, said she was surprised that the extract from the bitter melon she cooks in stirfries inhib its the frowth of breast cancer cell.
  
  "This is the first report describing the effect of bitter melon extract on cancer cells,"Ray said."We have shown that bitter melon extract significantly induced death in breast cancer cells and decreased their growth and spread."
  
  The expert decided to study the bitter melon extract's impact on breast cancer cells because previous researches have shown that the substance lowers blood sugar and cholesterol levels. Ray conducted her research using human breast cancer cells in vitor or in a controlled lab setting.
  
  "There have been significant advances in breast cancer treatment, which have improved patient survival and quality of life. However women continue to die of the disease and new treatment strategies are essential. Cancer prevention by the use of naturally occurring dietary substances is considered a practical approach to reduce the ever-increasing incidence of cancer. Studying a high risk breast cancer population where bitter melon is taken as a dietary product will be an important area of future research,"Ray said.
  
  She cautioned against seeing bitter melon extract as a miracle cure for breast cancer.
  
  After Long fight, cancer drug gives sudden reprieve
  
  For melanoma patients who signed on to try a drug known as PLX4032, the clinical trial was a last resort. Their bodies were riddled with tumours, leaving them almost just months to live.
  
  But a few weeks after taking their first dose, nearly all of them began to recover. Lee Reyes of California, who had begun using a feeding tube because of a growth pressing against his throat, ate a cinnamon roll.
  
  Randy Williams, who drove from Arkansas, to the Anderson Cancer Centre in Huston, said,"something's working, because nothing's hurting."
  
  It was a sweet moment, in autumn 2008, for Dr Keith Flasherty, the University of Pennsylvania oncologist leading the drug's first clinical trial. A new kind of cancer therapy, it was tailored to a particular genetic mutation that was driving the disease, and after six years of disappointments, his faith in the promise of such a "targeted" approach finally seemed borne out. His collaborators at five other major cancer centres, melanoma clinicians who had tested dozens of potential therapies for their patients will no success, were equally elated.
  
  The six doctors sent each other "before and after" CT scans of their patients. One was of Mark Bunting, 52, from Sandy, Utah. His initial scan in October showed the cancer in his bones, an incursion considered virtually impossible to reverse. After two months on the drug, it was gone.
  
  The trial of PLX4032 offers a glimpse at how doctors, patients and drug developers nagigate a medical forntier at a time when more drugs tailored to the genetic profile of a cancer are being widely tested on humans for the first time.
  
  Throughout the fall, the only two patients on the trial whose tumours continued to grow were the ones who did not have the particular genemutation for which the drug had been designed. By late December, tumours in the 11 patients who did have the mutation had shrunk.
  
  The firms that owned it spent months devising a new formulation that could be absorbed at higher doses. The doctors hoped that by pupshing up the dose they could kill the cancer more effectively.
  
  Kerri Adams, in Oklahoma City, woke up one morning covered in a rash. Another woman's hand swelled up, and she could not make a fist. A Philadelphia patient had horrible nausea and diarrhoea.
  
  Maybe the drug, designed to turn off only the defective B-RAF protein, was, at high doses, also affecting its role in healthy cells. Or maybe it was interfering with other proteins the body needed to function properly. On their next meeting, the doctors agreed to dial back the dose. As the side effects began to subside, many patients felt they had beaten their cancer.
  
  Tejaswini grew by 4 mm on Friday
  
  Mumbai: Friday's procedure at the P.D.Hinduju Hospital on Gude Tejaswini's right leg increased it by 4 mm in 16 minutes.
  
  A fall while cycling two years ago in her backyard resulted in Tejaswini experiencing excruciating pain and developing a swelling that refused to heal for days. The child specialist suspected the worst and referred her to Tata Memorial Hospital., where she was diagnosed with osteosarcoma (a cancer of the bones affecting mostly children and adolescents during their growth age between 10 and 20 years).
  
  *A majore chunk of her right thigh bone had to be sawed off to stop the spread of the tumour but her doctor, orthopaedic oncologist Manish Agrawal, managed to save the rest of her limb as well as her kneww joint. Doctors, however, could not save her growth plate in the knee cap (that determines the final length and shape of bones in adulthood).
  
  But technology has come in handy, saving the girl from the pain of repeated surgeries to remove discrepancies between the length of the two legs. It also saves hospital cost and cuts down chances of infection.
  
  
  Agrawal said technology now made it possible to avoid amputation in 80% of bone cancer patients. "So our priority is to ensure that they do not have to live with any handicap,"he said.
  
  BONING UP ON NEW TECH
  
  About 2,400 bone cases are diagnosed every year and just about one percent of all cancers is bone cancer. Osteosarcoma is the commonest type of primary bone cancer.
  
  It makes up for 35% of bone cancer cases and primarily affects children and young adults between the ages of 10-25.
  
  It often starts at the ends of bones, where new tissue forms as children grow. Knees are a common target.
  
  HOW TECHNOLOGY WORKS?
  
  * Following surgery to remove cancerous tumour, the patient is fitted with the non-invasive expandable implant, which can be increased in size without cutting open the limb.
  
  *The implant has a magnet placed inside along with a motor and a gear system.
  
  *A coil from outside generates an electromagnetic field that turns the motor inside the implant.
  
  *The miniature gears allow the movement of the motor, which expands the limb and works like a screw driver.
  
  Advantages
  
  *Repeated surgeries to manually increase the size of the a limb aren't required.
  
  
  *Apart from hospital stay, patient also saves on surgery complications and cost.
  
  *There is no pain or stiffness when the implant lengtheing is done.
  
  
  Disadvantages
  
  *As a patient grows up, there are some chances that the implant may break.
  
  *For a child who's undergone the procedure, a new adult implant may be required after a few years.
  
  *The gears inside the implant can heat up during lengthening. Doctors have to be aware that it does not cause any damage to the soft tissues.
  
  I TOOK BREAST CANCER HEAD ON, AND WON
  
  Being a fitness freak, the dreaded disease caught Asha Karandikar by surprise. What followed was a six-month long battle to reclaim her life. She reconts her story
  
  I am a single mom in Mumbai. That pretty much says a lot about my life. I have two kids, a son,16, and a 14 years -old daughter. Almost nine years ago, a stressful marriage resulted in painful separation, following which my husband refused to support our kids. My family couldn't bother less. So there I was, shuttling between a job, two kids and trying to build a home for myself.
  
  THE DISCOVERY
  
  One day, when taling to my friends, I casually mentioned feeling a hard marble-like lump in one side of my breast. They asked me not to take it lightly and go for a check-up. As the lump seemed suspicious, I was sent for more tests which confirmed cancer. My first reaction was that of utter disbelief, simply because I am quite health conscious, do yoga, and eat a healthy diet.
  
  I was told that I would need to undergo an operation where my breast would be removed. 'No way', I thought. Being a marketing executive for a media company, I meet a lot of people every day and looks matter. I gave in after intense counselling by my doctor.
  
  LEARNING CURVE
  
  Every visit to the hospital ws a novel experience. Thankfully, I had my support systems, my friends shobha and Lalita. Last April, I finally underwent the operation. My office too was supportive and allowed me to take a long break. Then chemotherapy took over. The six painful sessions of chemotherapy where I was injected with multiple units of a red liquid , was terribly painful- I felt an acidic burning sensation when it entered my body the first time. Your stomach almost feels like a pot of chemicals! The side-effects started showing too. Each time I ran fingers through my hair, a bunch came off. One day, out of dire frustration, I sat and simply 'brushed' off all of them.
  
  It isn't easy for a woman to lose her breast, her hair, and her health. But in a way I was lucky. Because my cancer was in the breast, I could feel the lump. Often in other forms of cancer(say, stomach cancer), it goes undetected for long.
  
  STAYING POSITIVE
  
  I knew I had to stay positive, else the treatment would take longer. In fact prolonged stress is one of the major reasons of cancer. Perhaps that was what caused it, in my case! I decided to take cancer head on, and win.
  
  Being a working woman throught, being quarantied at home was the worst part. To deal with it, I took up meditation every morning, which helped calm me down. I was of course frightened, and often stood in front of the mirror and counselled myself, telling everything would be okay. Friends and my kids were a big, source of strength. Many times, I didn't need to cook because my friends took care of it. At time, my daughter would take my head in her lap and console me, just like a mother would. That's why even today, I call her 'mommy'. My son is quite mature and understood the situation well.
  
  WAY AHEAD
  
  The happiest day for me was when I rejoined office last November, right in the thick of work, just how I like it. My tryst with breast cancer only made me stronger. I have started living for today and let go off the grudges that I held. I advise everyone to go for an annual health check-up; it's very essential.
  
  I have hit the gym to shed off the extra kilos that I had put on during treatment. My job is still as stressful, but I deal with it differently. I don't mull over things, but simply move on. My only agenda is to do better in my work and make something out of my talented kids. This is my second life, and I am ready to live it well.
  
  HOPE FOR BRAIN TUMOUR PATIENTS IN NEW TREATMENT
  
  Mumbai: It's not terrific news, but it sure does spell hope for a dismal diagnosis. Doctors and researchers are cheering a new finding in the cruel of world of gliomas, considered the most virulent form of brain cancer. While the median survival rate for glioma patients is one year, new medical protocols are ensuring an 11% survival rate of more than five years for patients diagnosed with grade-IV gliomas.
  
  Fifty-nine-year-old. Hitesh (name changed) is one of the few luky ones who was treated using the new protocol at Tata Memorial Hospital in Parel eight years back. Diagnosed with glioma in March 2001, he was the third patient to be put on the new protocol of Temozolomide along with surgery and aggressive radiotherapy.
  On Wednesday, Hitesh who teaches at one of the prestigious Indian Institutes of Techonology told TOI that apart from the rigours of the disease, he was glad that the treatment had worked well. "Brain tumours leave behind scars that take a toll on people's faculties,' he said.
  
  But his doctor, neuro-oncologist Rakesh Jalali at Tata Memorial Hospital in Parel, considers Hitesh one of the best examples of the triumph of medicine. "He is cured. In India we can now boast of 11% survival rates, unheard of a few years back,'says the doctor, whose team presented the hospital's research at the American Society of Clinical Oncology meeting in May 2009. In March 2009, data from a multi-centre European study published in the Lancet Oncology journal showed 9.8% survival rate of over five years for glioma patients.
• Indeed, gliomas that unually strike Indians in their 50s (in the West, it strikes people in their mid-60s) are worrisome, say doctors. Consider their biochemistry. Most brain tumours that develop from cancerous glial cells are called gliomas. Unlike other cancers, glioma tumours grow in the confined space inside the head. In order to grow, most cancers push healthy cells aside, but due to space constraints, glioma tumors destroy normal brain cells. They do so by releasing large quantities of the neuro transmitter glutamate that is toxic to neurons and causes seizures in up to 80% of people with gliomas. Depending on the tumour's size and location, other symptoms could include paralysis, behaviour changes and dizziness. A glioma tumor is particularly damaging because it tends to quickly sprout and spread within the brain. Each year, approximately 18,000 Americans find out that they have a glioma and many die within 12 months. Neurosurgeon Dr.Anandh Balasubramaninam, formerly with NIMHANS in Bangalore and now with Kokilaben Dhirubhai Ambani Hospital in Andheri, believes a five-year survival rate for glioma patients is inded a significant development. "Thanks to advances in medicines, we now confidently tell our patients that two-year survival rates are 70-80%. But to think about five-year survival is indeed an advancement," he added.
  
  Survivor Spreads Spirit of Hope
  
  Mumbai: When his doctor diagnosed a glioma, Subhash C Mishra refused to be cowered down."My doctor called up to say that he would send an ambulance right away to take me to hospital," says the professor of mechanical engineering at IIT Guwahati.The 45-year-old professor instead got into his car and drove down to the doctor's clinic, discussed his condition and planned a trip to AIIMS for a surgery.
  
  Post-surgery, he is in Mumbai for radiation therapy and on a mission."There is little awareness about brain tumour in society. I want to spread awareness about it even while helping patients to realise it is up to them to fight this foreign invasion of sorts on their brain," says Mishra, who volunteered to talk to patients at the Brain Tumour Foundation's get-together on Wednesday. He is in stage -III of tumour and will be back in February for a check.
  
  At present, he is making a documentary film on his treatment that he plans to screen for his students at IIT-Guwahati. "I came to Tata Memorial Hosipital in Parel because I wanted to meet others with the same condition. I don't feel disturbed. I feel sympathetic," says the teacher.