The latest discovery of the ICH4 test, which could rule out the need for chemotherapy in breast cancer patients and reduces chance of the cancer recurring has created a major buzz. However, there is no consensus among City doctors regarding its effectiveness
CANCER — the word brings about a sense of fear amongst many of us. Breast cancer has seen a growing number of instances over the year. Breast cancer also brings up the need for chemotherapy which many dread.
Dr P Raghu Ram, director and consultant oncoplastic breast surgeon, KIMS-Ushalakshmi Centre for Breast Diseases says, “The vast majority of patients receive chemotherapy after breast cancer surgery. Chemotherapy has a number of debilitating side effects which include nausea, vomiting, hair loss and fatigue. With an increasing number of breast cancers in India being diagnosed in 20 s, 30’s and 40’s, infertility is also a major effect of chemotherapy that one has to cope with.
The aim of chemotherapy is to minimise the chances of disease recurrence after breast surgery and most take it as there is no other alternative.”
Hope has now come in the form of a simple test which can detect whether a person has a chance of redeveloping cancer again and thus whether they require chemotherapy or not.
This new study was conducted by the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK.
Talking about the study Dr Raghu Ram says, “A study recently published in British Journal of Cancer outlines results from a simple and cost effective test that has been described by researchers at Royal Marsden NHS Trust in London which predicts accurately whether or not a subset of patients following breast cancer surgery will need adjuvant chemotherapy. The test called ICH4 could pick out the low-risk tumours and prevent these women from undergoing chemotherapy.”
The test works by measuring levels of ER, PR, HER2 and Ki67 proteins in the tumour.
This study that was conducted on 104 women whom were said to be at moderate risk of breast cancer. The test concluded that they actually were at low-risk and didn’t require chemotherapy after all.
At the outset this study appears to be something that could bring about a revolution. On the benefits of this finding, Dr Raghu Ram says, “It is very cost effective and has great relevance to a country like India. ICH4 test costs `10,000 — a fraction of the cost when compared with ONCOTYPE Dx which costs `2,00,000. ONCOTYPE Dx is currently being used world over which also predicts whether or not a subset of patients require chemotherapy after surgery.”
Dr Mohana Vamsi, chief surgical oncologist, Omega hospitals differs on his opinion, “This test is useful only for people in very early stages of breast cancer. Otherwise it is not of much use.”
Currently this is just a finding. It will take time before it is approved and hits the market for commercial use.
Dr Raghu Ram says, “These preliminary results which have just been published will need to be replicated in other Centres before it can be accepted for widespread use. The National Institute of Clinical Excellence (NICE) which is the drug licensing authority in United Kingdom will be evaluating the efficacy of this drug before it is widely accepted for use in the UK later this year.”
India and ICH4
The numbers of cancer and especially breast cancer cases in India have seen an increase. The formal introduction of this will definitely be a revolution.
Dr Raguram says, “It will indeed be very good news for patients in India if this test is approved for widespread use. Not only will a significant number of patients be spared of the need to have adjuvant chemotherapy with its debilitating side effects, but equally, this test will be affordable by many patients in India and hence has a potential for widespread use in our country.”
Dr Vamsi says, “The test may not be that effective in our country as in India cancers are usually detected a too late. By then chemotherapy is the only option.
It will be useful if the cancer is detected early and also there is still some time before it is clinically available.”