Immunotherapy: Hope for cancer patients

When you are diagnosed with cancer, it is not immediately a death sentence. Surprisingly, even with late-stage cancer, or at the brink of hospice care, you still have a chance at getting back to playing the band or flying a thousand miles to visit your grandson, or write your memoir. There is hope.

This is the kind of hope that Dr. Tanujaa Rajasekaran packed with her when she visited the Philippines in August to talk about cutting-edge cancer treatments. Dr. Rajasekaran is a young, sharp and erudite female doctor. A pretty and petite Indian medical oncologist based in Singapore.

She also speaks with compassion for the cancer-stricken. She is, after all, not just a doctor — but also a young mother that carries memories of a tragic tale when her daughter was diagnosed with metastatic ALK-positive lung cancer. Her child miraculously survived — from an oral targeted therapy. It is cancer medicine in the form of tablet or capsule, like taking vitamins.

Dr. Rajasekaran is one of the newest senior consultants at a cancer hospital in Singapore, the Parkway Cancer Centre. PCC advocates for hope. On its website, it says: “There is hope. And Parkway Cancer Centre is dedicated to sharing that hope to anyone and everyone affected by cancer. We are home to a comprehensive suite of cancer treatments.”

Many treatment options
“There are many options available,” Dr. Rajasekaran said, as she stood in front of a small group of audience, including some press people, in a conference room at the New World Hotel, Makati. Behind her was the glow of her deck presentation.

“Another one of my Filipino patients — a 70-year-old male,” she shared. “He had renal cell carcinoma, which is essentially kidney cancer. He was diagnosed in April 2020. He underwent surgery to remove the affected kidney. But one year later, he came back with abdominal pain, back pain. It was a metastatic occurrence, with the cancer spread to the lungs, to the peritoneum, which is the lining of the pancreas, the lymph nodes. He previously told me he had six months to live.”

Then the doctor showed the “before and after” images of her patient’s scans. After the patient was given three cycles of an immunotherapy drug, his tumor shrunk from 10 centimeters to 2.1.

“He just celebrated his 75th birthday and welcomed his great-grandson recently,” the doctor happily revealed.

Dr. Rajasekaran is particularly interested in epigenetic drugs (medicine to treat blood cancers) and bispecific T cell engagers (genetically modified cells injected into a cancer patient to attack tumors). She is a staunch advocate of immunotherapy, a type of cancer treatment that harnesses a patient’s immune system (your body’s natural defense army) to battle cancer cells and vanquish them (hopefully for good).

“The risk of dying from cancer is 20 percent,” she said. “These are very sobering numbers,” she said.

“The top five cancer in the Philippines is that of breast cancer, lung cancer, colorectal cancer, liver cancer and prostate cancer. The good news is that cancer care has advanced, really, over the last decade or so. But undeniably, cancer care is complex and require a multidisciplinary approach,” she optimistically said.

She talked about examples of targeted immunotherapy treatments for advanced or metastatic cancer (cancer that has spread), such as FDA-approved checkpoint inhibitors (administered through the vein) and proton therapy, where a patient is painlessly beamed with protons to destroy tumor cells. She described proton therapy to cause “less toxicities” compared to regular radiation (therapy).

“Proton therapy targets the tumor (does not affect normal cells). What happens is that it decreases toxicities, especially in our younger patients and reduced radiation-induced secondary cancers. And we can give a higher dose of radiation because it is more targeted and that can increase survival rates.”

CAR T-cell therapy
She then delved into a fascinating immunotherapy cancer treatment called the chimeric antigen receptor therapy or more popularly known as the revolutionary CAR T-cell therapy. A patient’s T cell (our white blood cells that fight viruses) is edited in a laboratory, released back into the body — but now armed with the ability to locate and attack the very smart and dodgy tumor cells. It’s synthetic biology. A reengineered super-cell, modified by the hands of man to fight a seemingly incurable disease.

It’s an expensive treatment. Experts estimate that CAR T-cell therapy can cost between $500,000 and $1,000,000, but some medical centers overseas offer in-house CAR-T cell therapy at significantly lower price ranges.

Dr. Rajasekaran cited Emily Whitehead, the first pediatric patient in history to receive CAR T-cell therapy at the Children’s Hospital of Philadelphia.

Diagnosed with acute lymphoblastic leukemia in 2010 when she was just five years old, Little Emily was about to die soon. Her parents, holding on to hope, had enrolled her in the first phase 1 trial for CAR T-cell therapy at CHOP.

Emily is now almost 18 and still cancer-free.

CAR T-cell therapy, an FDA-approved treatment, which is also being used to treat heart-failure patients, is a promising, hopeful treatment for some patients with blood cancers, such as Emily. But it is not yet a treatment for those with solid tumors, such as breast or prostate cancer.

CAR T-cell therapy also poses the risk for the patient to experience a life-threatening side effect, the CRS (cytokine release syndrome or widespread organ failure). It can affect up to nine in 10 CAR T-cell patients, according to Stanford Health Care. Little Emily suffered from CRS, but with prompt treatment at the ICU, she improved within hours, according to a report by CHOP.

CAR T-cell therapy is not yet available in the Philippines. The nearest place a Filipino cancer patient could get this type of immunotherapy treatment is in Singapore.

Cancer is a terrifying, time-consuming, expensive disease. But Dr. Tanujaa Rajasekaran and her team at Parkway Cancer Centre in Singapore are offering hope. And hope for the critically ill could result in miracles.