Landmark innovation brings hope for head and neck cancer patients with low-dose immunotherapy that reduces cost by 95%

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A majority of head and neck cancer patients in India can now afford immunotherapy treatment, currently exorbitantly expensive for most, thanks to an innovation by leading oncologists attached with the country’s premier cancer hospital Tata Memorial Centre in Mumbai.

Doctors at the Union government-run hospital have come up with a new low-dose immunotherapy treatment, which brings down the treatment cost from Rs 62 lakh to Rs 3.3 lakh per year, or about Rs 25,000 per month.

As part of this “budget-friendly” immunotherapy innovation, one-tenth of the immunotherapy drug Nivolumab is administered to prolong the lives of severely ill head and neck cancer patients.

Dr Vijay Patil, an oncologist with TMC who led the research along with colleagues Dr Kumar Prabhash, Dr Vanita Noronha and others, said the study findings showed that one-year survival rate in patients who received low-dose immunotherapy along with chemotherapy was dramatically higher at 43.4 percent in comparison to those who only got chemotherapy.

Only 16.3 percent of the patients in the second group who got only chemotherapy survived after one year.

Patil called it landmark research that may take immunotherapy to the masses and said that oncologists in India and other countries have already started recommending it to patients for whom the therapy is indicated.

“Now we know immunotherapy dose, lower than the company recommended dose, is also quite effective and our ongoing research involves patients of advanced-stage lung cancers,” he told Moneycontrol.

Prabhash, on the other hand, stressing that the findings from the study are very significant, also pointed out the limitations.

"This study, for example, does not suggest that low-dose immunotherapy can be used in all settings," he pointed out.

"Also, we need to prove low-dose immunotherapy role in different tumours and different settings before we consider this as routine in other settings."

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Findings of the latest one-of-its-kind randomised study were recently presented in the prestigious American Society of Clinical Oncology and doctors are hoping that the therapy will benefit more than 2-3 lakh patients each year in India and over 10 lakh across the globe.

Under immunotherapy, patients are given Nivolumab, which is classified as an "anti-PD-1 monoclonal antibody". The drug blocks the programmed death-1 or PD-1 protein receptor, which would normally attenuate the immune response.

By blocking it, the drug allows the immune system to work properly, and find and attack the cancer cells.

The primary purpose of Patil and his team was to make cancer treatment available to the masses and the accessibility is now expected to improve to at least about 75 per cent of head and neck cancer patients. Currently, the hospital sees about 15,000 patients with advanced stage of head or neck cancers every year but less than 3 percent of them can afford to opt for immunotherapy.

Patil and his colleagues at Tata Memorial tested the innovative therapy on 76 patients with metastatic head and neck cancers. This group was compared with another group of 75 similar patients who only got chemotherapy.

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All 76 were able to prolong their life as compared to the other group of 75 patients who only got chemotherapy. To conduct this study, definitive criteria were pre-set, for example, adult patients with relapsed-recurrent or newly diagnosed advanced HNSCC (head and neck squamous cell carcinoma, a type of head and neck cancer) being treated with palliative intent were eligible.

As part of the trial, half the patients received chemotherapy while the other half received chemotherapy with intravenous Nivolumab 20 mg flat dose once every 3 weeks. The therapy was continued until disease progression or intolerable adverse events.

Response assessment was performed every two months to assess the effectiveness and adverse effects.