This year’s Interim Budget focuses on vaccination against cervical cancer for girls aged 9 to 14. This is significant, given that cervical cancer is the second most common cancer afflicting women in India. World-wide, it is the fourth most common one.
Recently, model and actor Poonam Pandey, in a bid to raise awareness about cervical cancer, faked her death online, inviting wrath from the netizens. PR stunt or not, 'cervical cancer' was one of the trending topics on X that day.
THE WEEK caught up with Dr Rajeev Vijayakumar, consultant medical oncology, hemato oncology and BMT physician, Gleneagles Hospital Kengeri, Bengaluru, to talk about the breakthroughs in treatment for cervical cancer.
Q/ How do you view the focus on cervical cancer?
A/ The age-old adage ‘Prevention is better than cure’ is worth its weight in gold. Prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective ways to prevent cervical cancer and are very cost-effective. Cervical cancer can be cured if diagnosed at an early stage and treated promptly. Screening programmes, which are abundant in many centres across the country, have been a boon to many women. Boosting public awareness, access to information and services are key to prevention and control. Being vaccinated at age 9–14 years is a very effective way to prevent HPV infection, cervical cancer and other HPV-related cancers. Screening from the age of 30 (25 years in women living with HIV) can detect cervical disease, which when treated, also prevents cervical cancer. At any age, early detection followed by prompt therapy can cure cervical cancer.
Q/ What are the treatment options available?
A/ Treatment for cervical cancer is dependent on the stage. For patients with locally advanced cervical cancer (stage IIb–IVa), concurrent chemoradiotherapy has been the standard of care. For recurrent/metastatic cervical cancer, the standard of care has been Chemotherapy + Bevacizumab (a targeted cancer drug) providing an overall survival of 17 months.
Q/ What about immunotherapy?
A/ Immunotherapy becomes an exciting option for cervical cancers as they are caused by HPV infections. Hence, the cancer cells express markers that make them sensitive to immunotherapy agents like checkpoint inhibitors. Drugs like Pembrolizumab (Keytruda), Nivolumab and Atezolizumab have shown promising and exciting results. Single-agent immune checkpoint inhibitors (drugs that block immune checkpoint proteins from binding with partner proteins thus allowing T cells to kill cancer cells) are effective in late-stage cervical cancer, but combining them with CTLAA 4 inhibitors (drugs which allow T cells to kill cancer cells) or chemotherapy offers even better results than using immunotherapies alone.
Another area where combination immunotherapy appears advantageous is radiotherapy. Although radiation has historically been viewed as an immunosuppressant, there are a lot of data that radiation can enhance the antitumor immune response via a number of mechanisms. Research is ongoing to combine radiation with immunotherapies.
Q/ What about new drugs?
A/ A new family of drugs - bispecific antibodies are drugs which link the cancer cell to one side and the immune cell to the other. This gets the immune cell to dock on and kill the cancer cell. The drugs in this category are Bintrafusp and SHR – 1701.
Q/ What are the symptoms women need to watch out for?
A/ Women should seek medical attention if they have inter-menstrual bleed, bleed post sexual intercourse, excessive/foul smelling vaginal discharge or persistent low back ache. While therapies for cervical cancer have improved to a large extent over the last decade, but early detection is still the key.