Transforming Paediatric Cancer Outcomes: A Shift Towards Precision Medicine

Dr Mohanaraj Ramachandran, Consultant- Pediatric Oncology and BMT, Cytecare Hospitals, Bengaluru, in this article explores the evolving landscape of pediatric cancer therapies in India, emphasising the importance of tailored treatments to enhance outcomes

Pediatric cancer presents a significant healthcare challenge in India, with an estimated incidence of 50,000 to 75,000 new cases annually. This figure accounts for approximately one-fifth of the global burden of pediatric tumours, which is around 300,000 cases per year. The data may understate the actual incidence due to under reporting, highlighting an urgent need for enhanced detection and treatment strategies.

The survival rates for childhood cancers have markedly improved over the past several decades, rising from around 10-20 per cent in the 1960s to an impressive 70-80 per cent today. This progress can be attributed to advancements in treatment modalities and a better understanding of the biological underpinnings of these diseases. However, despite these gains, challenges persist, particularly in access to care and the adaptation of treatment protocols to meet the unique needs of Indian children.

The Indian scenario: Incidence and challenges

The Indian Cancer Society indicates a rising incidence. This is likely due to improved detection methods. Factors contributing to this increase are not fully understood, and comprehensive screening protocols for childhood cancers are not yet feasible.

The most common types of paediatric cancers include leukaemias, brain tumours, and lymphomas. Each of these malignancies presents unique treatment challenges. Moreover, many children in India face a higher risk of treatment complications due to malnutrition and other socioeconomic factors.

Treatment modalities: From conventional to cutting-edge

Traditionally, the management of pediatric cancers has relied on chemotherapy, surgery, and radiotherapy. However, the advent of targeted therapies and immunotherapies has marked a significant shift in treatment paradigms.

Targeted therapy and immunotherapy

Targeted therapies focus on specific genetic mutations or protein expressions associated with tumours, enabling more precise and effective treatments.

Immunotherapy, on the other hand, enhances the body's immune response against cancer cells. In India, therapies such as CAR-T cell therapy have emerged as revolutionary options, particularly for relapsed or refractory cases of B Acute lymphoblastic leukaemia (B-ALL) and B-cell lymphomas.

CAR-T therapy, although currently approved only for patients aged 15 and above in India, has shown promising trial results for younger populations. The cost-effectiveness of this indigenous therapy—approximately one-fifth to one-sixth of its Western counterparts—enhances its accessibility. As research progresses, we anticipate broader applications for CAR-T therapy, potentially revolutionising treatment strategies for pediatric cancers.

Genetic testing: A key to tailored treatments

One of the most significant advancements in pediatric oncology is the use of genetic testing to inform treatment decisions. For relapsed or refractory cases, genetic profiles can guide the selection of targeted therapies, thereby individualising treatment plans. This approach minimises unnecessary toxicity and efficacy, aligning with the principles of precision medicine.

Advances in research and protocol development

Despite significant strides, pediatric oncology in India still relies heavily on Western treatment protocols. The need for Indian-specific protocols is critical, particularly considering the unique genetic and environmental factors influencing cancer in our population. Initiatives like the Indian Pediatric Hemato-Oncology Group (INPHOG) are paving the way for developing localised research and treatment protocols, enabling better management of childhood cancers in India.

Risk stratification: A customized approach

Risk stratification has become a cornerstone of pediatric cancer treatment. By categorising patients based on genetic factors and clinical presentation, oncologists can tailor treatment intensity to individual needs. For instance, standard-risk patients may receive less intensive chemotherapy, reducing the risk of complications, while high-risk patients receive more aggressive treatment.

Future directions: The promise of chemo-free treatments

The future of pediatric cancer treatment is moving towards less toxic and more effective modalities. The potential to utilize CAR-T therapy as a frontline treatment for certain leukaemias presents an exciting frontier. Should CAR-T therapy be proven effective and safe for broader age groups, it could significantly reduce the reliance on traditional chemotherapy, minimising the associated risks of infections and long-

term complications.

Moreover, the integration of late-effect monitoring into treatment protocols reflects a growing awareness of the long-term impacts of cancer therapies. Understanding and mitigating the potential late effects of treatment—such as cardiac or pulmonary complications—are essential for improving the overall quality of life for survivors.

Conclusion

As we navigate the complexities of pediatric cancer treatment in India, the emphasis on tailored therapies and personalised medicine will be critical in improving patient outcomes. Continued collaboration among healthcare providers, researchers, and policymakers is essential to enhance awareness, improve treatment protocols, and ultimately provide the best possible care for children battling cancer.

In a rapidly evolving field, staying informed about the latest advancements and participating in clinical trials will be vital for healthcare professionals dedicated to paediatric oncology. Together, we can work towards a future where every child with cancer has access to effective, personalised treatment options that not only aim for cure but also prioritise their long-term health and well-being.