Dr Suresh Advani, director of the department of Medical Oncology at Jaslok Hospital and Research Centre reviews the progress of medical oncology in India and talks over the significant contribution of the hospital to the field with its involvement in large international clinical trials, particularly phase I trials. He laments a certain unwillingness on behalf of multinational companies to invest in clinical research in India while noting a shift in patient engagement as patients become more willing to participate in trials.



Could you begin by introducing yourself briefly and sharing your current focus, considering your different responsibilities?

I began my journey in oncology in 1974, focusing on medical oncology at a time when surgical and radiation oncology dominated the field. Over the years, medical oncology has evolved into a recognized and dominant discipline here in India. In the past, it was limited to a few cities, requiring people to travel long distances for treatment. However, there has been a transformative shift, and today, comprehensive oncology services are available even in small villages across the country. The accessibility and availability of oncology services have significantly improved. This widespread accessibility marks a significant transformation. Moreover, the global trend towards online platforms, accelerated by the COVID-19 pandemic, has remarkably enhanced knowledge dissemination. Now, individuals in smaller towns and villages are as informed as their urban counterparts, fostering a more inclusive and informed medical community.

In terms of my current focus, I acknowledge that research has taken a back seat in India, with more emphasis on clinical applications. While basic science research is limited, there are pockets of activity, particularly in premier universities. Clinical research, including participation in international trials, has gained momentum, contributing to the advancement of medical knowledge and patient care.


Looking at the progress from lab to patients in oncology, can you elaborate on the specific impact your hospital has made in this regard? Which areas do you believe have the greatest potential?

The hospital where I work has a significant impact in the field of oncology, particularly in research and international collaborations. We are known for our involvement in big international trials, contributing to advancements in the field, such as new drugs and new combinations. In terms of specific areas, we observe a rarity in conducting phase one trials in India. Clinicians are interested, and the government is supportive, but there is a notable lack of investment and confidence from pharmaceutical companies, both domestic and multinational.

The reluctance to invest in phase one trials is multifaceted. One aspect is the fear of generic molecule development in India, even though the regulatory environment has evolved. Additionally, there may be concerns related to following international laws. The pharmaceutical industry, including multinationals, seems hesitant to make substantial investments in this crucial phase. It is a gap that requires exploration and dialogue to understand the barriers and work towards fostering more confidence and investment in phase one trials.


Is there a comprehensive national oncology strategy in place in India, or is it still a work in progress?

While the government plays a supportive role, the initiatives currently underway are predominantly driven by healthcare providers. Our commitment is to provide optimal treatment to our patients, and there has been a notable shift from the days when patients would be diagnosed at home and unfortunately pass away. Today, patients actively seek advanced treatment options, progressing from first-line to third-line and beyond. The landscape has transformed, and patients are now keen on participating in clinical trials, indicating a significant shift in patient engagement.


Can you shed any light on the existing policies, plans, or schemes in India concerning the facilitation and carrying out of clinical trials?

It appears that initiatives in this domain are quite individualistic, with various institutions and individuals taking the lead, not solely within the pharmaceutical industry.

Shifting gears to financing, I would like to explore the role of the private sector in this context. Particularly, when it comes to later-stage treatments like the third or fourth line, it seems to be more self-driven.

On the note of accessibility, it is impressive to hear that cancer treatments and drugs are widely available across the country. The majority of these drugs, including both established and recently developed ones, are generic, creating a phenomenal impact. The ease of online access and consultations further enhances the overall accessibility and convenience for patients.


Are India’s homegrown pharma companies actively investing in and contributing to the advancement of oncology?

The pronounced emphasis on oncology development is apparent, with companies actively engaging in the creation of innovative drugs, such as antibodies and antibody-drug conjugates. This indicates a positive trajectory, especially as major drug patents expire, allowing for the introduction of new and improved treatments. The commitment to providing the best possible care to patients is evident, ensuring both quality and affordability are prioritized in the oncology landscape.


What potential do precision medicines and cell and gene therapies have in India, given their often expensive nature?

From my perspective, precision medicine is already integrated into our practices. For instance, the cost of gene testing for diseases like lung cancer has significantly been reduced, and results are delivered promptly. India is rapidly advancing technologically, and these services are available at an affordable costs. In lung cancer cases, for instance, every patient’s first-day sample is routinely sent for comprehensive genetic analysis.


As the field continues to evolve, what, in your opinion, should be the focus to sustain this positive trajectory?

It is crucial to ensure that our services remain not only effective but also cost-effective. Striking this balance is essential for the majority of patients to access and benefit from advanced treatments. Many institutes are already offering subsidized and complex treatments at lower costs, leveraging the advantage of the large patient population in India.


Looking ahead three to five years, what transformations or advancements do you anticipate in the field?

I envision a scenario where the standard of cancer care becomes uniform across India. This would eliminate the need for patients to travel long distances to access quality care. Unifying treatment standards will bridge the gap between urban and rural areas, making advanced treatments accessible to a broader population.


To conclude, is there any message you would you like to convey to government stakeholders and industry players in India?

I commend the efforts undertaken, such as establishing multiple centers, especially in regions like Kerala. However, there is still progress needed in some areas. The goal should be to ensure consistent and high-quality cancer care across the country, ultimately benefiting all patients, regardless of their geographic location.