Challenges and Changing Trends in the Treatment of Haematological Cancers

Abstract

Chemotherapy and radiotherapy were the only weapons against cancer in the past. Research has opened up many vistas
for treatment— different classes of drugs, targeted therapy, monoclonal antibodies and immunotherapy to name a few—that
have become available in routine practice for the treatment of cancer. This was possible due to research grants/funds and
pharma interest to detect new antigens with pharmacogenomics that identified targetable drugs against the antigens on the
malignant cells. Disease eradication was the end point in the past that was achieved with great difficulty. With novel agents
targeting different antigens through new drug routes and newer drug combinations, including “chemotherapy free” treatment, we seem to be doing better with less toxicity in treatment naïve and relapsed patients, who can now get another shot at a disease-free survival or clinical remission. Currently many protocols utilise a combination of drugs- one belonging to
the older generations and one novel agent (chemoimmunotherapy), a combination of new agents (chemotherapy free protocols), or a combination of subcutaneous and oral medications in the treatment of various malignancies. Futuristically, our aim is to use therapy which avoids / reduces hospitalization with a finite duration of therapy, making treatment cost-effective and more compliant leading to better and deeper malignant cell destruction. However, with the ever evolving and mutating cancer cell for its survival, novel drugs will become old tomorrow and our protocols, combinations and sequencing of drugs will change over time with the advent of new drugs. The singular end point in cancer treatment today is better efficacy, safety and user-friendly protocols (oral or subcutaneous routes) that will achieve a deep response - undetectable minimal residual disease (uMRD) that will ultimately lead to treatment discontinuation. This in turn will improve compliance, prevent unnecessary toxicity and hopefully provide a functional cure. We are nearly there but we still do not routinely use the word cure…yet! Hopefully someday.