Cancer is a complex and potentially life-threatening disease that consists of various types depending on the organ of origin and underlying genetics. Cancers can be vastly different in their age of onset, severity, the speed of progression and overall impact on the cancer patient’s quality of life and survival.
Consequently, the treatment approaches adopted for different Cancer types are also different and customized to disease characteristics. Furthermore, Cancer treatment options vary dramatically depending on the Stage of the Cancer. Generally early stage Cancer (Stage 0, 1 and 2) can be treated with Localised treatment. Whereas, more advanced stages (Stage 3 and 4) require Combination, Systemic or Palliative treatment (there are exceptions to this).
You should work closely with your Oncologist to understand the Cancer type, stage and the corresponding Standard Treatment options relevant to your specific case. You should stay open to all Standard Treatment possibilities, but also be aware that there are thousands of New Cancer Treatment options in a developmental stage every year that may be an option for you.
This article is a broad introduction to the context (curative or palliative intent of treatment) and the various cancer treatment that may be applicable in these situations. This understanding will assist in your ability to understand Oncoshot’s clinical trial recommendations and your ability to have a more informed discussion with your Oncologist about your trial options.
Qn 1: What does your Cancer Treatment aim to achieve?
The ideal aim of every Cancer Treatment would be to completely cure the Cancer and help the patient regain a normal life. But this is not possible in every individual. Depending on the Stage of Cancer [0 to 4], Cancer treatments have to be customized to entirely different objectives ranging from the intention of a complete cure to helping the patient cope with symptoms and prolong survival with an emphasis on quality of life.
1a. Curative or Primary Treatment: Removal or Cure of the Cancer
This treatment option is sometimes called the First or Primary treatment. When the Cancer is localised to the organ of origin, the primary treatment is used with a curative intent, which means to remove the entire Cancer lesion and to theoretically cure the body completely of the Cancer. The most common treatment option for Curative or Primary treatment is Surgery. If your Cancer type is historically known to respond to Chemotherapy or Radiation therapy, then one of these treatments or a combination can used as the Curative or Primary treatment option.
1b. Control or Suppression: Adjuvant and Neoadjuvant Treatments
Adjuvant therapy is given after the Surgery or the primary treatment to control or suppress any residual Cancer cells in the body. The aim of the Adjuvant therapy is to prevent any relapse due to the presence of residual Cancer cells after Surgery. Depending on the Cancer type and Stage, chemotherapy, hormonal therapy, radiation therapy or its combinations can be used as Adjuvant therapy.
Neoadjuvant therapy refers to Cancer treatment similar to adjuvant therapy being given before the Surgery. The primary objective of Neoadjuvant therapy is generally to improve outcomes by increasing the effectiveness of Surgery by reducing the size of the Cancer tumour and destroying early micrometastatic disease (cancer that is present outside the primary tumour but is not visible on imaging tests).
1c. Palliative Treatment: For Symptom Control, improvement in quality of life and/or overall survival
Palliative Treatment is primarily chemotherapy, targeted therapy and immunotherapy given in the context of advanced or metastatic cancer which cannot be theoretically cured. The aim of such treatment is to improve the control of symptoms arising from the cancer, improving the Quality of Life for the patient and prolonging survival in an individualised manner.
It is worth noting that with advancements in cancer science, modern therapies such as targeted therapy and Immunotherapy have enabled prolonged disease control in certain tumour types. With modern clinical trials, researchers hope that patients with advanced cancers may have suitable treatment options that enable long term disease control if not cure.
The control of symptoms like nausea, vomiting, pain, etc. can lead to a significant improvement in the quality of life of the Cancer patient. Various other treatments including non-cancer medicines for Pain Management, Nausea, Diarrhoea and Breathlessness can be used as Palliative treatment to improve symptom control and Quality of Life.
Where possible, Palliative Care Specialists should be engaged early to ensure that cancer patients are managed holistically. They are an important pillar of cancer care not only for terminally ill patients but also for individuals who may be in the early phase of their treatment journey for advanced cancer.
Qn 2: Tell me more about the specific Cancer Treatment Options for localised disease
Depending on the location and the spread of the Cancer in the body, Localised or Systemic treatment options can be chosen. Localised treatments are focused on treating Cancer in a specific body part or region. Systemic therapy, on the other hand, is drugs that are given through the bloodstream and they spread across the entire body.
2a. Local Treatment: Surgery
Surgery as described above is the most frequent Primary treatment option used with Curative Intent for localised disease. Sometimes Surgery can also be used in more advanced stages to remove as much Cancer disease as possible to decrease the Cancer burden on the body and to control its spread. Surgery can be used along with Adjuvant or Neoadjuvant therapy to increase its effectiveness. Surgery can also be used as a Palliative treatment to relieve Pain or other symptoms in the Cancer patient.
2b. Local Treatment: Radiation
Radiation or Radiotherapy or Irradiation therapy consists of high-energy waves or radiation that is used to damage or destroy the cancer cells in a localised region. Radiation destroys the genetic material of the Cancer cells and can be used to cure or decrease the size of early-stage Cancer. Radiation can also be used as Adjuvant or Neoadjuvant therapy along with Surgery or as Combination therapy along with Chemotherapy. Radiation therapy is effective and used in the majority of solid tumours. Radiation can be given from outside the body as External Radiation or as Brachytherapy from inside the body.
2c. Local Treatment: Systemic Therapy
Systemic therapy is the Cancer treatment given through the bloodstream so that the treatment affects all the body parts. Systemic therapy is generally used to treat Cancer that has spread to multiple organs in the body but may be also used in cancers such as lymphoma or germ cell tumour in the context of localised disease. The various types of systemic therapy are further discussed below.
Qn 3: What are the different types of Systemic Therapy for advanced Cancer.
3a. Chemotherapy
Chemotherapy drugs are the most prevalent form of Systemic therapy used for Cancer. There are close to a hundred different chemotherapy drugs that can be used as Systemic therapy for various types of Cancer across the world. Chemotherapy drugs are also called Cytotoxic drugs because they interfere with the growth of rapidly dividing cells in the body. Hence along with the Cancer cells the Chemotherapy drugs also affect the cells in the gastrointestinal tract (leading to nausea, vomiting), the hair follicles (causing hair loss) and the bone marrow (leading to decreased blood counts). Chemotherapy drugs can also be given together as Combination therapy to increase their effectiveness. Chemotherapy is also the commonest form of Adjuvant and Neoadjuvant therapy.
3b. Targeted Therapy or Precision Medicine
The development of Precision Medicine or Targeted Therapy for Cancer has completely transformed the methods and objectives of Cancer Treatment. Through the development of Genetic Medicine, certain proteins, molecules or genes have been identified that lead to the conversion of normal cells to Cancer cells. These molecules can be different for different Cancer types. In Precision Medicine, these molecules are used as Targets for developing New Drugs that specifically block these molecular Targets and hence stop the growth of Cancer cells. In the last few decades, Targeted Therapies are developed and approved by the US FDA for various Cancers including Breast Cancer, Lung Cancer, Skin Cancer, Leukaemia, Lymphoma, Prostate Cancer, and Pancreatic Cancer. Molecular and Genetic Biomarkers are also used to detect patients that are positive for particular molecular targets. Targeted treatments generally have lesser adverse effects because the therapy is designed to act only against the Cancer cells in your body, and not the normal cells..
3c. Immunotherapy
Immunotherapy is another highly advanced form of Cancer Treatment. Your Immune System is the natural defence mechanism of your body. In Cancer, the Immune System fails to protect the body from the Cancer cells. Immunotherapy can work by stimulating the Immune System against Cancer or by adding some artificial Immune Components to aid the normal Immune Response. Immunotherapy is one of the essential parts of Cancer Treatment in the past few decades. Monoclonal Antibodies (including Checkpoint Inhibitors), Cancer Vaccines, Interferons, Interleukins and CAR-T cell therapies are some of the common Cancer Immunotherapy agent categories.
3d. Hormone Therapy
Hormonal therapy is another common form of Systemic therapy in Cancers that are dependant on Hormones for their growth. Breast Cancer and Prostate Cancer are two common Cancers in which drugs are used to stop or block the effect of Oestrogen (female hormone) and Androgen (male hormone) on the Cancer tissue. Hormone therapy stops the growth of the hormone-dependant Cancer tissue.
How Oncoshot Can Help You?
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