Chemotherapy: From an Accidental Discovery to the ‘Standard of Care’

The use of mustard gas in treating Cancer during World War I was although inadvertent, it is one of the key milestones in the treatment of cancer. Though the term ‘Chemotherapy’ was first used in the early 20^th century, it was during the 1940s that the term was reintroduced in the context of cancer treatment. Over the years, chemotherapy has evolved with various approved and recommended regimens.

The word ‘Chemo’ refers to the chemical substance and ‘Therapy’ refers to the treatment. Naturally, Chemotherapy refers to the treatment of ‘any disease’ using drugs. However, in recent times, the word ‘Chemotherapy’ is ultimately associated with the treatment of cancer.

Chemotherapy, the cornerstone in the management of cancer

Chemotherapy is the most preferred choice of therapy since it has advantages over conventional treatments such as surgery and radiation. Local treatments such as surgery and radiation act upon the affected body part whereas chemotherapy is a systemic approach in treating cancers with an intent to kill cancer cells that might have metastasized to different parts of the body. Chemotherapy may be a viable alternative in situations when local treatments are not an option.

Chemotherapy as Standard of Care (SoC)

Curative intent: It is important to note that the term ‘cure’ is rarely used in the treatment of cancer but the term ‘Curative Intent’ is often used with the hope of curing the disease. Chemotherapy is generally recommended with ‘curative intent’ based on the stage and type of the disease with an aim to eliminate cancer cells and achieve long-term remission in scenarios such as:

• Adjuvant therapy, recommended treatment after surgery or radiation therapy with an aim to eliminate cancer cells that might have escaped the primary treatment increasing the risk of recurrence.
• Neoadjuvant therapy is generally recommended before starting with primary therapy such as surgery in order to downsize the tumor such that it is rendered operable which was initially regarded as inoperable.
• Combination treatment, Chemotherapy is often used in combination with other treatment modalities with the intent to synergize the treatment efficacy by targeting cancer from different angles.

Control of cancer: Depending on the stage of cancer, some cases may not be curable but rather controlled like a chronic illness such as diabetes. Therefore, in such cases, chemotherapy is recommended with the intent to control the spread of cancer cells and shrink the size of the tumor in order to increase longevity.

Palliative treatment: This type of treatment is recommended when the cancer is in an advanced stage and cannot be controlled due to its spread across the body. The intent of palliative care is to improve the quality of life by reducing the symptoms.

Why Chemotherapy is the preferred choice?

• As a first step in treating cancer, chemotherapy drugs being cytotoxic will focus on controlling the growth and spread (metastasis) of cancer cells.
• Chemotherapy drugs are intended to act regardless of underlying patients’ genetic profiles. The working mechanism of these drugs is comparable to the bombing at the war site with the intent to kill maximum number of soldiers. 
• Certain cancer types such as lung, ovarian, and testicular cancers are known to respond quickly to chemotherapy relieving symptoms and reducing tumor size.
• They act on a wide range of cancer types from solid tumors to heme cancers (blood cancers) and some chemotherapies are relatively cost-effective in comparison with other treatment modalities.
• Additionally, regulatory authorities have approved chemotherapy regimens and standard guidelines recommend chemotherapy as the first line of therapy, making chemotherapy, a readily available option.

Challenges with Chemotherapy treatment

The Non-selective mode of action of chemotherapy targets ‘healthy cells in the gastrointestinal tract, hair follicles that are rapidly dividing making the patient vulnerable to side effects such as hair loss, nausea, and vomiting.

One of the major concerns with chemotherapy treatment is the development of resistance by cancer cells which essentially means that the cancer cells are changing their identity. In such cases, the patient would require advanced treatment options such as targeted therapy.

Despite the ‘invent of advanced medicine’ and ‘certain challenges with chemotherapy’, it still stands as the most preferred choice since

• The use of targeted therapies requires genetic testing to confirm the target where tissue availability is often a limiting factor.
• Chemotherapies are extensively studied, approved, and recommended which makes it a feasible option at the first go.
• With cancer cells constantly changing their identity (genetic signature), chemotherapy is used with the aim to control the spread and growth of cancer cells.

#chemotherapy #cancer #cancertreatment #cancermanagement

Wildlife on butcher’s weighing scale!

As a young kid, I remember watching my mother spread food grains over a piece of cloth under the sun. Sun drying of various food grains like rice, wheat and few others used to be a common activity in every Indian household. It was such a pleasure to watch especially because grains spread under the sun attracted birds.

Unlike today’s generation who are hooked to mobile games; for a kid grown up during 80’s and 90’s, watching household activities was sort of an entertainment. I always watched these birds curiously as they would walk all over the spread, relentlessly moving their head, scanning the entire spread of food grains and diligently choosing their food. When they came across a stone or any inedible stuff, they would vigilantly ignore and move ahead. Once they are done, they would happily fly away and mostly come back when they needed.

At this moment in time of corona outbreak, every one of us would have definitely read about wildlife farming. Well, wildlife farming is the act of raising non-domesticated animals such as tiger, pangolin, and wild boar to name a few, in an agricultural setting mostly for human consumption, decorative and medicinal purpose. In farm setting, offspring is produced by inbreeding where mating is done between genetically identical individuals (like siblings or close cousins). And that is the reason why farm animals have very weak immunity and are usually not instinctive as the wild varieties (like the broiler chickens or the tigers that you could find in places like tiger temple (Kanchanburi, Thailand). Even today in India marriage between close cousins is forbidden for the risk of hidden genetic disorders being developed in future generations.

And yes, one of the purposes of wild life farming happens to be human consumption and at this point I am reminded of those conscious birds that chose their food carefully. It now seems to me that they knew all that they could digest and all that are edible! We, human beings, who are supposed to be the most intelligent animals on earth, are somewhere failing to even make this simple distinction. As a result, we are often gifted with newer zoonotic diseases such as SARS, MERS. Probably, we will be posed with many more if we let go off ‘humane’ from human beings then all that we will be left with is just ‘being’.

I was always taught since my childhood that wild animals are very furious hunters and now the present day kids would be learning the same too. However, I foresee that kids in the near future would in turn question that if wild animals are furious hunters and human beings are exploiting them; then shouldn’t human beings be called wild animals?

Now when I look back, I hear the cries of all those ladies who would yell at the birds ‘all my grains have been eaten away’, yet somewhere they had the satisfaction of feeding the innocents. And those were the times when wild animals were being watched in movies or channels like NGC or Animal planet. My heart goes for those notorious birds who grabbed their food and stealthy wild animals who would roam freely in wild jungle, both of which are on the verge of extinction.

Nevertheless, it is our responsibility to let these animals live in wild and their birthright to freely roam in jungles but undeniably not to be weighed on butcher’s weighing scale.

#Personalizedmedicine #Cancer

MUTE WORLD

One fine morning, like any other day, I began my day waiting for a city service bus at the bus stop. After waiting for couple of minutes, I boarded a bus to reach my workplace which is about an hour away from my residing place. Having gotten into a pretty crowded bus, I somehow managed to find a little place to stand, though uncomfortably. Bus continued through its way like a snail, moving bumper to bumper which is an everyday scene in our busy and crowded ‘Namma Bengaluru’.

A passenger was seated comfortably on a seat adjacent to me whom I envied for a moment. Fortunately, soon I found vacating her seat which I caught eagerly like an eagle catching its prey. Though, I had just crossed two stops, it felt like I was standing since ages in those long stretches of still vehicles waiting for those traffic signals to turn green. Having found a seat, I sat and began to enjoy with great relief to my tired legs.

Like every other day, I took a novel out from my bag and started to read. I usually prefer to use travel time to read to avoid boredom and frustration caused by traffic jams. As I continued reading, a man appeared in the scene standing next to my seat and handed a bag over to me. Handing over their luggage to people who are seated is common in Bengaluru so that they can stand freely in crowded buses.

Slowly, I found this man standing next to me leaning towards my seat which made it difficult for me to sit. Uncomfortable feeling started to build up in me and I started making faces to show my irritation but I never looked up at him. Soon I realized that it was not just me who had a feeling of irritation and a bit of anger too but people standing around that eccentric man too shared the same feelings. This man was annoying almost everybody in the bus with some strange sounds which was literally noise for me.

That morning’s center of attraction, a middle-aged man’s notorious act continued for a long time yelling at people, making alien sounds. By the time, we reached close to my destination with just two stops away from my workplace, a lady seated next to me vacated her seat. Unfortunately, I found this man finding his way to the vacant seat next to me. Having seated comfortably, he made peculiar action and sound at me and that’s when for the first time I lifted up my head to look at him to understand what this man is up to. To my shock and surprise, I found that this man is mute yet trying to talk to every creature in the bus. Coming into my senses, I understood through his actions that he was asking me for time. I found myself stuck with words in my throat with practically no words escaping my mouth, I just showed him my watch with a smile. After answering his query, he was ready to put forth his next question to continue the conversation which I answered with smile and a nod but not a single word. As I had reached my destination and got up to alight, he bid me farewell with an enthusiastic and a million-dollar smile. In turn, I threw my poor smile at him and nodded my head in reply to his wishes for the day. After alighting, I stood at the platform turning back again and again to look at this man and found that he was eagerly waiting for his meeting with another stranger.

Though, my meeting with this man was just for few minutes, he had left me with awakening thoughts. For the rest of the day, I kept wondering who is indeed MUTE. What had sounded like a noise to me a few minutes ago, had turned zealous and anger faded. In this fast and busy life where we are isolating ourselves from our own people, I found this Archangel reminding us with our extra-ordinary quality of SPEECH and it hit over my head reminding me to use it before it turns vestige.