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Current status in India: |
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The first attempt at starting a multi-centric trial to treat childhood acute lymphoblastic leukemia (ALL) in India started way back in 1984. Pediatric oncologists from three leading institutes across India viz. All India Institute of Medical Sciences (AIIMS), New Delhi, Tata memorial Hospital (TMH), Mumbai and Cancer Institute, Chennai got together and in collaboration with the National Cancer Institute (NCI) ,USA, planned a multi-centric protocol for childhood ALL. Dr. Ian Magrath from the NCI, helped design the protocol considering the available facilities and resources at that time. The MCP841 protocol was implemented from 1986 onwards. |
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MCP 841 was a relatively intense chemotherapy protocol for children and young adults up to 25 years of age with newly diagnosed ALL. Over the years accrual increased and results started improving. |
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When the results of this protocol were last analyzed in 2004, the 5 years EFS for all 3 centers for the period 1990 – 1997 ranged from 41 – 60%. Considering that before the initiation of this protocol, the survival rates in childhood ALL in India were < 30%, there has been vast improvement. |
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Oncology residents from different parts of the country, who trained in any of these 3 major tertiary centers, got familiar and comfortable using this protocol for children with ALL. They started using this protocol for treating childhood ALL in their individual centers. |
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Apart from the improvement in the survival rates, this effort of starting a multi-centric research protocol had several other advantages. |
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Firstly it got the entire treating team attuned to treating patients on clinical trials. It ensured detailed documentation of clinic visits, laboratory reports and hospitalization records. |
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Secondly treating a large volume of patients on a uniform protocol taught to anticipate complications and thereby prevent them or treat them early. |
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Thirdly it trained everybody involved in data collection and data recording. Thus it brought a lot of discipline in the system ensuring better adherence to the protocol. |
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Most practicing Pediatric Hematologists Oncologists in India have obtained fellowship training from foreign universities or have trained in tertiary institutes within the country itself. Childhood cancers are not always treated by them, but by adult physicians, adult medical oncologists and sometimes in smaller centers by radiation / surgical oncologists who have experience with chemotherapy for adult solid tumors. |
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Thus secondary and tertiary centers all across the country treat children with malignancies. They use different protocols for different diseases depending on familiarity and comfort and their own previous experience with the protocol. Unfortunately there are very few published results and no national data regarding the characteristics and treatment outcomes of childhood malignancies in India. |
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Need of the hour: |
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For the past few years there is a felt need among the Pediatric Hematology Oncology community in India to get together to form a national co-operative group. India stands to be the world’s second most populous nation with a population of over one billion, of which 31% is constituted by children less than 14 years of age. The resultant burden of childhood cancer is phenomenal, posing a huge challenge. But with this challenge comes a great opportunity - the opportunity to conduct large clinical trials in an effort to improve survival. |
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There is paucity of data regarding the nature of childhood malignancies in our country. Hence there is a felt need to conduct our own trials. There is a need to study the nature and biology of different malignancies as to how they differ from those in the West. Our patients differ racially and genetically from patients in the West and hence differ in their tolerance and metabolism of drugs. Implementing Western protocols does not always give similar results. There is a need to develop indigenous protocols. |
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The formation of a national co-operative group will help being together institutions with pediatric cancer units. |
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It will help collect and record data, thereby enabling to know better the incidence and epidemiology of childhood cancers in India. |
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It will help to run clinical trials and research protocols across the country. |
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Institution in turn will have the backing of a national co-operative group in treating children with malignancies. |
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It will help improve overall care and outcomes by sharing expertise and experiences. |
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