Small benefits, big impact: Understanding the value of novel drugs in metastatic cancer

Dr Jahnavi Pedireddy, Medical Oncology Trainee, Apollo Hospitals, Bengaluru; Dr Narendhar Gokulanathan, Medical Oncology Trainee, Apollo Hospitals, Bengaluru; Dr Muthulingesh Kumar, Medical Oncology Trainee, Apollo Hospitals, Bengaluru; and Dr Vishwanath Sathyanarayanan, Professor and Head, Department of Medical Oncology, Apollo Hospitals, Bengaluru; delve into the clinical, economic, and emotional complexities of adopting novel cancer drugs, especially in lower-middle income countries

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Metastatic cancer refers to malignancies that originate in one organ and spread to adjacent or distant organs via the blood or lymphatic systems. tumour cells continuously shed into the circulation, and while many are cleared by the immune system, some manage to evade immune defences and travel to distant sites in the body. Interestingly, different cancers tend to metastasise preferentially to specific organs. For example, breast cancer commonly spreads to the bones, brain, liver, and lungs, while lung cancer often metastasises to the adrenal glands, bones, brain, and liver. Prostate cancer tends to spread to bones, liver, lungs, and adrenal glands, and colorectal cancer typically involves the liver, lungs, and peritoneum.Clinically, metastatic cancer is categorised based on its relationship to the primary tumour site:

♦ Locally advanced cancer involves nearby tissues or lymph nodes.

♦ Regional metastasis refers to spread to adjacent organs or areas.

♦ Distant metastasis is cancer that has travelled to far-off organs, often through the blood stream or lymphatics. Historically, the management of metastatic cancer has relied on four primary therapeutic modalities: surgery, radiation therapy, chemotherapy, and, more recently, immunotherapy. The 2018 Nobel Prize in Physiology or Medicine was awarded to Tasuku Honjo and James Allison for their discoveries in cancer immunology.

Professor Honjo was awarded due to his discovery of the programmed death molecule-1 (PD-1) on T cells.

Localised treatments like surgery and radiation are directed at specific tumour sites, while systemic treatments such as chemotherapy and immunotherapy target cancer cells throughout the body.