WIN 2011, 6-8 July, 2011, Paris

Personalised medicine and cancer control in India

Dr Rita Mulherkar – Tata Memorial Centre, Mumbai, India

My group is working on genomics of cervical cancer and we have been working on this project for about five years now, before that I was working on some other projects. So we are trying to look at… we’ve done gene expression profiling and we’ve done whole exome sequencing in a few number of patients and what we want to see is if we can get a signature of genes which will tell us which patients will respond to therapy. Because we have a very good follow-up on these patients, the biopsies were collected before treatment was given and this was more than ten years ago, so we have a good follow-up and we’re trying to see which are the patients who respond and which are the patients who don’t respond.

We are also looking at the HPV status in these individuals and we are trying to see whether the site of integration of HPV is important, whether it tells us something about how these patients’ disease will progress.

Do you think Indian patients should be included in more international trials?

I feel that we should be part of these clinical trials because there are ethnic differences and we may be completely different; the response to therapy could be different in the Indian patients so we need to be part of the clinical trials. Personally I feel that personalised medicine is going to be the future of medicine. So we need to know what are the mutations in different genes, whether they’re the same as in the Western population and whether there are patients who will respond just as well to the targeted therapy.

Are there big international trials on-going that are involving the Tate Centre?

There are a lot of on-going clinical trials where some of our patients are enrolled but I don’t think any of them are for such kind of a trial where you pick up patients and give a targeted therapy based on the mutations in the tumour.

What can be done to tackle cancer in India?

Actually I’m sure you know, two of the commonest cancers in India, both are preventable, I think. One is oral cancer and the other is cervical cancer; oral cancer is mainly because of the tobacco chewing habit. Both these cancers have a pre-cancerous lesion which, if one can screen these individuals then you can catch them early. But screening is very expensive and also after screening when you find someone has a lesion or someone has an early lesion, someone that you would take them for treatment and I don’t think we have enough places where they can be treated. So some of these problems have to be taken care of and we can bring down the incidence of both these cancers.

Is there any government intervention?

Government intervention is mainly for infectious diseases, not so much for cancer because we have tuberculosis and diseases like that which also need to be screened. Polio, for example - polio vaccination is a big project which is going on by the government and screening for cervical cancer is really not going on, although our hospital does some screening in the peripheral villages around Bombay. I think if we have a very quick, simple, cheap test for early detection, I think that would help and I hope that we can come up with something like that. You know China has come up with a test for HPV testing which is really very cheap and quick and I think if we can just screen women for HPV and for lower individuals who are positive for HPV, high risk HPV types like 16-18, that itself would bring down the incidence of cervical cancer.